Analysis Of The Curative Effect Of Vagus Nerve Stimulation On Intractable Epilepsy And Its Complicated Depression

Objective:to verify the safety and efficacy of vagus nerve stimulation(VNS)in the treatment of drug refractory epilepsy(DRE),to explore the best stimulation parameters after VNS,and to analyze the effect of VNS on depressive symptoms in patients with DRE.Methods:We selected the fifteen patients with refractory epilepsy who received VNS in our hospital from January 2014 to December 2018.The preoperative condition(frequency,duration,type,etc.)were collected,and the scores of Baker self-rating Depression scale(BDI)and Hamilton Depression scale(HAMD)were used as the baseline level.All the patients were treated with VNS.The follow-up time nodes were 6 months,12 months and 24 months after surgery,the family members of the patients were asked to record the seizures through the epilepsy diary.At the same time,we asked the patient’s family members to keep an epileptic diary to record the seizure situation.During the follow-up,the epilepsy diaries were collected and recorded,BDI and HAMD depression tests were performed to record adverse events,and the stimulation parameters were adjusted according to the epilepsy control of the patients.The average seizure reduction rate,effective rate,Mc Hugh grade,BDI and HAMD score reduction rate were used to evaluate the efficacy of VNS.The data before and after operation were analyzed by self-paired t-test(P<0.05).Results:the average seizure reduction rates of 15 patients at 6months,12 months and 24 months after operation were 32.03%,37.61% and52.51%,respectively,and the effective rates were 13.33%,33.33% and 40%,respectively.24 months after operation,the Mchugh grade reached grade Ⅰ in 1 case,grade Ⅱ in 5cases,grade Ⅲ in 9 cases,and no grade Ⅳ and Ⅴ patients.The decreasing rates of BDI score at 6 months,12 months and 24 months after operation were 20.9%,45.23% and63.34%,respectively,and the decrease rates of HAMD scores were 17.65%,39.41% and61.61%,respectively,and the depressive symptoms of all patients were significantly improved.During the follow-up,there were 2 cases of transient hoarseness and cough related adverse reactions.The best effect was obtained when the stimulation current was1.18±0.52 m A,pulse width 250～500 μs,stimulation frequency 20～30 Hz,stimulation parameter 30 s and intermittent time 3～30 min.Conclusion:As a neuroregulatory surgery for refractory epilepsy,VNS has a certain ability to improve the patients with refractory epilepsy and their depressive symptoms,and the effect has a time-cumulative effect;Stimulus parameters need to be individually programmed.