Effective treatment for drug-refractory epilepsy

  At present, in clinical practice, epilepsy treatment is ineffective in about 30-40% of patients taking a large number of antiepileptic drugs, and it is difficult to perform surgery because the seizure site identification is unclear. For these patients who have not been able to find satisfactory treatment for a long time, who are not effective with various antiepileptic drugs, who have frequent seizures, who are recalcitrant, and who can even affect their behavior emotionally and only, are called refractory epilepsy.  Although many patients can achieve satisfactory results through traditional surgical means, these methods not only cause pain to patients, but also make surgical treatment difficult to be effective because many lesions cannot be identified, or many patients are reluctant to undergo surgery because of behavioral disorders after surgery. In recent years, it has been found that intermittent row vagus nerve electrical stimulation (VNS) can bring intractable seizures under control or cause a significant reduction in the number of seizures, opening up a new treatment avenue for intractable epilepsy. Since 1997, when VNS treatment was first approved for clinical use by the FDA, vagus nerve stimulation has been increasingly used as a new treatment for intractable epilepsy, and has been approved in the United States and Europe for the treatment of adolescents and adults with intractable epilepsy over the age of 12 years. The procedure is simple, non-craniotomy and low risk. The vagus nerve is isolated in the neck and wrapped around a wire, and a stimulator is placed through a subcutaneous incision in the chest.  The results of the surgery: many years of domestic and international studies have shown that: 1. the severity and duration of seizures are reduced after surgery 2. the overall quality of life is improved.  One scholar reported 29 patients with VNS and found a continuous reduction in seizure frequency at 1 year follow-up. There was a 50% reduction in seizure frequency in 13 patients and at least a 75% reduction in seizure frequency in 6 patients. Another scholar followed up 7 patients after VNS for 15 months and found that 1 patient had complete remission of seizures, 6 had a reduction in seizure frequency and duration.  Indications for surgery: partial, especially complex partial seizures, or complex partial seizures followed by generalized seizures; frequent seizures, averaging more than 6 seizures per month or with a maximum interval of less than 14 days in two years; no history of psychiatric disorders, asthma, cardiopulmonary disease or other progressive developmental disorders; proven ineffective with at least 1 month of phenytoin sodium or carbamazepine or both.  Contraindications to surgery: peptic ulcer, cardiac arrhythmia, pregnancy, poor general condition.