Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study.
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Roth Jonathan, Bergman Lottem, Weil Alexander G, Brunette-Clement Tristan, Weiner Howard L, Treiber Jeffrey M, Shofty Ben, Cukiert Arthur, Cukiert Cristine Mella, Tripathi Manjari, Sarat Chandra Poodipedi, Bollo Robert J, Machado Hélio Rubens, Santos Marcelo Volpon, Gaillard William D, Oluigbo Chima O, Ibrahim George M, Jallo George I, Shimony Nir, O'Neill Brent R, Budke Marcelo, Pérez-Jiménez María Ángeles, Mangano Francesco T, Iwasaki Masaki, Iijima Keiya, Gonzalez-Martinez Jorge, Kawai Kensuke, Ishishita Yohei, Elbabaa Samer K, Bello-Espinosa Luis, Fallah Aria, Maniquis Cassia A B, Ben-Zvi Ido, Tisdall Martin, Panigrahi Manas, Jayalakshmi Sita, Blount Jeffrey P, Dorfmüller Georg, Bulteau Christine, Stone Scellig S, Bolton Jeffrey, Singhal Ashutosh, Connolly Mary, Alsowat Daad, Alotaibi Faisal, Ragheb John, Uliel-Sibony Shimrit
Аннотация
METHODS: This multinational, multicenter retrospective study focuses on LGS children who underwent CC before the age of 18 years, following prior VNS, which failed to achieve satisfactory seizure control. Collected data included epilepsy characteristics, surgical details, epilepsy outcomes, and complications. The primary outcome of this study was a 50% reduction in drop attacks.
RESULTS: A total of 127 cases were reviewed (80 males). The median age at epilepsy onset was 6 months (interquartile range [IQR] = 3.12-22.75). The median age at VNS surgery was 7 years (IQR = 4-10), and CC was performed at a median age of 11 years (IQR = 8.76-15). The dominant seizure type was drop attacks (tonic or atonic) in 102 patients. Eighty-six patients underwent a single-stage complete CC, and 41 an anterior callosotomy. Ten patients who did not initially have a complete CC underwent a second surgery for completion of CC due to seizure persistence. Overall, there was at least a 50% reduction in drop attacks and other seizures in 83% and 60%, respectively. Permanent morbidity occurred in 1.5%, with no mortality.
SIGNIFICANCE: CC is vital in seizure control in children with LGS in whom VNS has failed. Surgical risks are low. A complete CC has a tendency toward better effectiveness than anterior CC for some seizure types.