OBJECTIVE Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE. METHODS We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort. RESULTS Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy. SIGNIFICANCE Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.

中文翻译：

---

迷走神经刺激治疗难治性特发性全身性癫痫：爱尔兰回顾性观察研究。

目的 由于可用的治疗选择有限，难治性特发性全身性癫痫（IGE；也称为遗传性全身性癫痫）是一项临床挑战。虽然迷走神经刺激 (VNS) 被批准作为耐药性局灶性癫痫的辅助治疗，但支持其治疗难治性 IGE 的疗效的证据有限。方法 我们对 2003 年 1 月至 2022 年 1 月期间接受 VNS 治疗的成年 IGE 患者进行了单中心回顾性分析。我们分析了该 IGE 队列中 VNS 反应的有效性、安全性、耐受性、刺激参数和潜在临床特征。结果 2003年1月至2022年1月期间，23名IGE患者接受了VNS植入。其中22名患者（95.65%）为女性。中位基线癫痫发作频率为每月 30 次（四分位数间距 [IQR]= 140），包括全身强直阵挛发作 (GTCS)、失神、肌阵挛和伴/不伴失神的眼睑肌阵挛。基线抗癫痫药物 (ASM) 的中位数为 3 种 (IQR= 2)。患者之前平均未通过 6 次 ASM (IQR= 5)。在研究期结束时，17 名患者 (73.9%) 的 VNS 治疗仍然有效。在继续 VNS 的患者中，有 13 名（占整个队列的 56.5%）被视为有反应（癫痫发作频率减少≥50%）。在分析的临床变量中，只有精神合并症与较差的癫痫结果相关，但在应用 Bonferroni 校正后不显着。尽管 16 名患者报告了副作用，但没有人导致 VNS 治疗停止。意义 超过一半的难治性 IGE 患者对 VNS 治疗有积极反应。当其他治疗选择已用尽时，VNS 为难治性 IGE 患者（尤其是女性）提供了一种可行的治疗选择。