Moderator: Ma Yanhong, reporter of this newspaper
Guest Expert: Professor Zhang Jianguo, Director of Functional Neurosurgery Department, Beijing Tiantan Hospital, Capital Medical University, and Director of Functional Neurosurgery Research Department, Beijing Neurosurgery Institute, has won the second prize of Wang Zhongli Medical Award Fund, the prize of 100 outstanding young doctors in Beijing, and the third prize of Chinese Medical Science and Technology. The research on “Brain Pacemaker”, which has been highly valued by the Ministry of Science and Technology of China, Beijing Municipal Committee and Beijing Municipal Science and Technology Commission. Zhang Jianguo, Department of Functional Neurosurgery, Beijing Tiantan Hospital
The fourth International Epilepsy Care Day was celebrated on June 28th, and relevant units in more than 30 cities nationwide have carried out different forms of public education and expert consultation activities. Professor Zhang Jianguo, director of functional neurosurgery at Beijing Tiantan Hospital, Capital Medical University, told reporters that in recent years, the development of new anti-epileptic drugs and the continuous progress of surgical procedures have increased patients’ confidence in curing the disease.
Reporter: At present, epilepsy has become a common and frequent disease in China, what are the characteristics of epilepsy incidence in China?
Prof. Zhang Jianguo: The incidence of epilepsy in China is on an increasing trend, from 4.4% in the 1960s. It has increased to 5.5% at present. ~7%. It is noteworthy that the incidence of epilepsy in rural areas of China is significantly higher than that in urban areas, which is related to many factors such as lower standard of living in rural areas, more risk factors that women may be exposed to during pregnancy, and lower level of perinatal care.
However, at present, many patients are not receiving standardized treatment. Some patients and their families have a clear sense of shame about the disease and seek treatment for it. This provides a market for unregulated treatment facilities under the guise of a “cure”. Therefore, promoting knowledge about epilepsy, eliminating social discrimination and prejudice, and standardizing clinical treatment have been important issues in epilepsy prevention and treatment.
Reporter: How to weigh and choose the treatment for epilepsy?
Prof. Zhang Jianguo: At present, there are various treatment methods for epilepsy, such as drug therapy, surgical resection therapy, vagus nerve stimulation, and deep brain stimulation. These methods are not an either/or relationship, and clinicians should carefully weigh the pros and cons and tailor the treatment plan to the individual patient in order to control the condition more ideally.
The majority of patients with epilepsy can be treated with medication, but 20% to 30% of patients with drug-refractory epilepsy are still difficult to control effectively after medication.
In recent years, surgical treatment of epilepsy has developed rapidly, but there is still a large gap in surgical treatment in China. The basic principles of surgical procedures include removal of abnormal discharging lesions and cutting off the related neuronal conduction pathways. The location of the abnormally discharged neurons determines the choice of surgical mode, and the lesions cannot be surgically removed if they are in functional brain areas. It is worth mentioning that in recent years, a surgical treatment technique called “vagus nerve stimulation (VNS)” has been popularized abroad for its safety, simplicity, minimal damage, and few side effects, and has been welcomed by doctors and patients.
VNS was developed by Texas Cyberonics in 1988 and entered clinical research in the same year, and from 1988 to July 1997, more than 1,000 patients around the world received clinical research on VNS. To date, more than 60,000 patients have been treated with vagus nerve stimulation in over 75 countries worldwide.
Reporter: What is the mechanism of vagus nerve stimulation?
Prof. Zhang Jianguo: The vagus nerve is an important connection between the body and the brain, conducting sensory and motor information from the body to the brain and from the brain to the body. There is one on each side of the body.
The implantable treatment system for vagus nerve stimulation includes pulse generators, leads, diggers, programming rods, patient toolboxes, software and a palmtop computer.
During the procedure, two small incisions are made in the neck and left side of the chest after the patient is under general anesthesia, and a small pacemaker-like pulse generator, about 6.99 mm thick and 52 mm in diameter, is implanted – sending electrical stimulation to the left branch of the vagus nerve in the neck, which transmits the electrical stimulation to the brain to reduce the irregular discharges that cause epilepsy. The frequency of the electrical pulses from the pulse generator varies from patient to patient, sending stimulation to the brain for approximately 30 seconds every 3 to 5 minutes, with the output current intensity adjusted to the patient’s actual needs. The device is programmed to work 24 hours a day after a physician or nurse sets the device. In general, the battery life is 6 to 11 years.
Of note is the system’s “instant-on” feature. When a patient feels a seizure coming on or during a seizure, a magnet can be rubbed across the device relative to the body surface to activate the device immediately, which can stop the seizure, shorten the duration of the seizure or reduce the intensity of the seizure.
Reporter: What new research results have been achieved in vagus nerve stimulation therapy carried out at home and abroad?
Prof. Zhang Jianguo: The results of foreign bulk case statistics show that 24 months after vagus nerve stimulation, the average number of seizures was reduced by about 50%. 5%-9% of patients had complete cessation of seizures; 7% of patients had more than 90% reduction in seizures; 30% of patients had more than 75% reduction; 55% of patients had more than 50% reduction; 13% of patients had only 30%-50% reduction in seizures In 10% of patients, the reduction was ineffective.
In another study conducted abroad that included 3822 patients with epilepsy, the number of seizures decreased by 47.0%, 52.9%, 60.0%, 62.7%, and 66.7% at 3, 6, 12, 18, and 24 months after vagus nerve stimulation; at 24 months after surgery, seizures stopped completely in 8.3% of patients, decreased by more than 90% in 26.8% of patients At 24 months, 8.3% of patients had complete cessation of seizures, 26.8% had more than 90% reduction, 43.7% had more than 75% reduction and 62.2% had more than 50% reduction.
Studies have shown that common side effects after vagus nerve stimulation are hoarseness of the voice, abnormal sensation (tingling sensation in the skin), difficulty breathing, and increased cough. A common side effect in implantation surgery is infection.
To date, a total of 83 cases of vagus nerve stimulation have been performed in China. Due to the limitation of treatment cost (the implantation device costs more than 100,000 yuan), the number of cases completed in China before 2009 was relatively small, totaling 31 cases. In recent years, related research has progressed rapidly, with 47 cases completed in 2009 alone, more than the total number of previous cases, and 5 cases completed in January 2010. The overall results are relatively satisfactory.
Related links
Epilepsy is a chronic disease in which sudden abnormal discharges of neurons in the brain cause transient brain dysfunction.
Seizures are a clinical phenomenon caused by abnormal and excessive hyper-synchronized discharges of brain neurons. It is characterized by sudden and transient symptoms, which may vary depending on the location of the abnormally discharged neurons in the brain, and may be motor-sensory or autonomic with or without changes in consciousness or alertness.