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Ergebnisse der Vagusnervstimulatorimplantation bei Kindern und Jugendlichen mit therapierefraktärer Epilepsie

Results of vagus nerve stimulator implantation in children and adolescents with treatment-refractory epilepsy

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Zusammenfassung

Die Vagusnervstimulation (VNS) ist ein palliatives Therapieverfahren bei Patienten mit therapierefraktärer Epilepsie, für die epilepsiechirurgische Verfahren nicht infrage kommen. Die Wirkmechanismen der VNS sind bis dato nicht vollständig geklärt, scheinen aber mitunter auf Änderungen der Zusammensetzung von Neurotransmittern zurückzuführen zu sein. Die Daten von 25 Patienten mit pharmakoresistenter Epilepsie und Implantation eines Vagusnervstimulators wurden retrospektiv monozentrisch ausgewertet. Es bestand 3 Monate nach erstmaliger Aktivierung eine durchschnittliche Reduktion der Anfallsrate um 28,0 %, nach 6–12 Monaten von 32,9 %. Die Responder-Rate, (die Reduktion der Anfallshäufigkeit von > 50 %) 6–12 Monate nach erstmaliger Aktivierung im Vergleich zu vor der Implantation lag bei 40 %. Bei einem Drittel der Patienten reduzierte sich die Anfallshäufigkeit sogar um mindestens 75 %. Unerwünschte Wirkungen durch die Operation oder die Stimulation waren selten.

Abstract

Vagus nerve stimulation (VNS) is a therapeutic procedure that can be applied in a palliative setting in patients with treatment-refractory epilepsy who are not suitable for epilepsy surgery. The mechanism of action of VNS is currently not completely understood but appears to depend on a modification of neurotransmitter metabolism. Data of 25 patients with treatment-refractory epilepsy who underwent implantation of a vagus nerve stimulator were retrospectively analyzed in a monocentric study. A reduction in epileptic seizure rate of 28% was observed 3 months after initial activation and of 32.9% after 6–12 months. The responder rate (reduction in seizure rate of more than 50% compared to before implantation) was 40% 6–12 months after initial activation. In one third of patients, a reduction in epileptic seizure rate of at least 75% occurred. Adverse effects of surgery or the stimulation were rare.

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Authors and Affiliations

  1. Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Tumorzentrum, Klinikum Region Hannover GmbH, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland

    Kim Vanessa Steinke, Hartmut Möbius & Hans-Jürgen Welkoborsky

  2. Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland

    Kim Vanessa Steinke, Hartmut Möbius & Hans-Jürgen Welkoborsky

  3. Abteilung für Neuropädiatrie, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland

    Hans-Jürgen Christen

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  1. Kim Vanessa Steinke
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Correspondence to Kim Vanessa Steinke.

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K.V. Steinke, H. Möbius, H.‑J. Christen und H.‑J. Welkoborsky geben an, dass kein Interessenkonflikt besteht und dass keine persönlichen Vorteile durch die Implantation der Geräte entstanden sind.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Steinke, K.V., Möbius, H., Christen, HJ. et al. Ergebnisse der Vagusnervstimulatorimplantation bei Kindern und Jugendlichen mit therapierefraktärer Epilepsie. HNO 70, 389–395 (2022). https://doi.org/10.1007/s00106-022-01164-y

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