[Hot Spot] First use of vagus nerve stimulation in the treatment of refractory epilepsy in children

Release date: 2016-10-12

Recently, the first neurosurgery successfully performed vagal nerve stimulation for two children with drug-refractory epilepsy.

He is 11 years old and has refractory epilepsy and hypoxic ischemic encephalopathy. He has had seizures for 9 years. Dada is only 5 years old, he was diagnosed with symptomatic epilepsy, Doose syndrome (myoclonus with standing can not be epilepsy syndrome), at the age of two, there was a loss of paroxysmal consciousness, upper limbs, and falls.

The chief physician of the Department of Neurosurgery, Li Yunlin, evaluated the situation of two children and thought that they belonged to severe epilepsy syndrome and epileptic encephalopathy. The common symptoms were convulsions, and they were in sports, growth, and mental development. Obviously behind the same age children.

Epilepsy, commonly known as "shofar mad" and "goat epilepsy", is a chronic recurrent transient brain dysfunction syndrome characterized by repeated epileptic seizures caused by abnormal discharge of brain neurons. The overall prevalence rate is 7.0‰, annual incidence. It is 28.8/100,000. Epilepsy is a chronic disease, and long-term frequent episodes can cause serious impact on the body and mind and intelligence of patients. Patients with epilepsy are treated with regular anti-epileptic drugs, and about 70% of patients have control over their seizures. However, there are also anti-epileptic drugs for two years or more, and the condition is still uncontrollable. This situation belongs to drug-refractory epilepsy, and vagus nerve stimulation (VNS) can greatly improve the disease.

Vagus nerve stimulation was proposed in 1988 by Dr. Jacob Zabarra of the United States, and then applied to the clinic. It is believed that stimulating the vagus nerve may change the potential in the brain, thereby blocking or even preventing seizures. It has been used by patients all over the world. In about 80% of patients, epilepsy can be improved, and 50% of patients can reduce their seizures by half.

The advantage of vagus nerve stimulation is that it is easy to operate and has long-term effects. Compared with craniotomy, it is relatively safe and has few side effects. This technology has also been carried out in adult hospitals in China, but there are not many cases. Compared with adults, the advantage of children using this technology is that epilepsy is at the initial stage of the disease, the treatment effect is better than that of adults, and may return the child to the normal orbit of growth and development.

The vagus nerve stimulation is to surgically place the coil on the vagus nerve in the left neck, and the stimulation device is buried under the chest. The operation can be completed in one to two hours, and the patient is turned on three weeks after the operation. To adjust the parameters and modes of the stimulation device, the machine will automatically stimulate the vagus nerve according to the set mode to achieve the purpose of controlling seizures.

If the child's seizure is a precursor, when he feels that there is a precursor in his home or other occasions, he can use an easy control device and stroke it across the chest to generate additional stimulation to interrupt. An impending epileptic seizure, or a reduction in the onset time and a reduction in the severity of the episode.

After 5 hours of surgery, the two children successfully operated successfully. After the surgery, it takes two to three weeks to observe the normal start-up stimulation. During this period, the doctor will pay close attention to the bleeding and infection of the operation. At the same time, the children will be followed up regularly, and the stimulation parameters will be adjusted according to the condition.

Source: Beijing TV Station "Urban Evening Peak"

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