I. Epilepsy and traditional treatment means
The concept and characteristics of epilepsy: epilepsy is a transient brain dysfunction disease caused by abnormal and excessive discharge of neurons in the brain, and there are many causes of abnormal brain discharge. In the data published by this study, the first cause is still unknown, that is, no cause can be found, and the proportion is 68.7%. ), head trauma (4.1%), brain tumor (3.6%), infection (2.6%) and others (2.3%). Seizures have two characteristics: one is paroxysmal, which means that the brain does not have abnormal discharges 24 hours a day, and the other is unpredictable. Patients with epilepsy often cannot know exactly when they will have a seizure, and therefore often suffer physical injury as a result of the seizure.
Traditional treatment of epilepsy: Most people with epilepsy need to take antiepileptic drugs to control the disease, but the effectiveness of medication varies from person to person and cannot be 100% at present. The percentage of patients who are well controlled with a single or multiple antiepileptic drugs is about 64%, while the other 36% have seizures regardless of the type of antiepileptic drug or combination of drugs they try.
Traditional surgical treatment of epilepsy involves finding the lesion of abnormal brain firing and surgically removing it. First, it is an open brain surgery, which is relatively dangerous; second, the type of seizure must be localized, that is, the abnormal discharge is produced by a local area of the brain rather than a comprehensive and widespread simultaneous discharge; third, the foci of abnormal discharge can be identified; and fourth, the foci can be removed and will not cause serious complications because of the local removal of the brain. Fourth, the lesion can be removed without serious complications or sequelae due to the localized removal of the brain. Because of these limitations, epilepsy surgery is not suitable for all patients with epilepsy.
The principle of vagus nerve stimulation.
The vagus nerve is the 10th of 12 pairs of brain nerves in the body and is part of the autonomic nervous system. The vagus nerve is a mixed nerve, containing sensory, motor and parasympathetic fibers. The vagus nerve innervates most of the organs of the respiratory and digestive systems as well as the sensory, motor, and glandular secretions of the heart. Anatomically, the vagus nerve emanates from the vagus nucleus located in the posterior medial aspect of the medulla oblongata, passes through the jugular foramen to the neck, and then enters the chest and abdomen. Vagus nerve stimulation is performed on the part of the nerve that emanates from the brain and passes through the neck. The theory of vagus nerve stimulation was proposed in 1988 by Jacob Zabarra, an American physician, who believed that stimulating the vagus nerve might change the electrical potential in the brain, thus blocking or even preventing seizures. However, in animal studies, it was found that stimulation of the vagus nerve was effective in controlling seizures. This idea was later developed by Cyberonics as the NeuroCybernetic Prosthesis System (NCP), which has been used clinically in patients with epilepsy.
The vagus nerve stimulation procedure: First, a coil is surgically placed on the vagus nerve in the left neck and the stimulation device is buried in the chest, then at each patient visit, the medical staff adjusts the parameters and mode of the stimulation device through the instrument, and the machine automatically stimulates the vagus nerve according to the set mode to achieve seizure control. If the patient’s seizure has a precursor, when the patient feels a precursor at home or on other occasions, a small structure with a magnet inside can be used and crossed on the chest to produce additional stimulation to interrupt the impending seizure, or to reduce the duration or severity of the seizure.
Currently, about 80% of patients worldwide who have used vagus nerve stimulation to help control their seizures have some improvement in their epilepsy, and 40% of patients have had their seizures reduced by half. This effect can be maintained over time, and seizure control outcomes may increase over time. In addition, some patients experience improved mood, wakefulness, and memory through vagal stimulation of the brain. It may also improve the quality of life of patients with epilepsy by reducing the amount of antiepileptic medication and the chance of being taken to the hospital for seizures.
There are some side effects associated with vagus nerve stimulation, including temporary throat rasping and pitch changes, coughing, throat tickling, and shortness of breath when the machine is first adjusted, which is caused by stimulation of certain body structures that are innervated and controlled by the vagus nerve itself. A few patients with long-term use have reported transient heart rhythm changes, or arrhythmias. Patients with this device should avoid short wave, microwave or therapeutic ultrasound therapy, and there is no definitive answer as to whether magnetoencephalography will have an effect on the device. In summary, the use of this non-traditional surgical vagus nerve stimulation to help control epilepsy requires a visit to a large, specialized, formal epilepsy hospital with a full epilepsy treatment team. The results need to be followed up and evaluated.
Advantages and disadvantages of vagus nerve stimulation.
The advantages are
Vagus nerve stimulation has been used by patients all over the world and has been shown to reduce seizures.
It is relatively safe and has less side effects than epilepsy surgery.
The effects are long-term.
The device is easy to operate.
The disadvantages are
Results vary from person to person and may not be suitable for some people (e.g., to achieve complete seizure freedom).
The price is more expensive than other treatments.
Indications.
Patients with epilepsy between the ages of 12 and 60, focal or partial seizures secondary to generalized seizures, failure to effectively control the condition with regular treatment with one to three antiepileptic drugs, and multiple or unlocalizable lesions. Surgical treatment will not cause significant functional deficits.
Contraindications: The presence of progressive neurological disorders, psychiatric disorders, cardiac arrhythmias, peptic ulcers, or poor general condition are contraindications to vagus nerve stimulation treatment.
It is a good treatment for patients with significant drug side effects and inappropriate for surgery, and is effective in patients with generalized seizures and pediatric epilepsy.