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Combined surgical intervention with vagus nerve stimulation following corpus callosotomy in patients with Lennox-Gastaut syndrome

  • Clinical Article - Functional
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Abstract

Background

Lennox-Gastaut syndrome (LGS) is a drug-resistant pediatric epilepsy characterized by multiple seizure types, including drop attacks (DAs). Palliative procedures such as corpus callosotomy (CC) and vagus nerve stimulation (VNS) may be effective for adequate seizure control in LGS patients who are not candidates for resective surgery. We evaluated the efficacy of the combination of these two procedures for LGS-related seizures.

Method

Ten patients with LGS (age 3-30 years at VNS implantation) underwent CC and subsequent VNS. We evaluated surgical outcomes, particularly with respect to the efficacy of VNS on seizure reduction rates for different residual seizure types after CC. We compared clinical parameters, including sex, age, seizure duration, history, MRI findings, extent of CC, number of antiepileptic drugs, and neuropsychological states, between VNS responders and non-responders to predict satisfactory seizure outcomes with respect to residual seizures after CC.

Findings

VNS was effective for residual seizures regardless of seizure type (except for DAs) after CC in patients with LGS. Six of ten (60%) patients had a satisfactory seizure outcome (≥50% seizure reduction) for all residual seizure types after VNS. Two of ten (20%) patients were seizure-free at 12 months post-VNS. Even those patients that were non-responders, with respect to all seizures including DAs, after prior CC showed favorable responses to subsequent VNS. Compared to VNS, excellent seizure outcomes for DAs were achieved after CC in seven of nine (77.8%) patients with DAs. Among the clinical parameters, only conversation ability before VNS was significantly different between responders and non-responders (p = 0.033).

Conclusion

Combined VNS and prior CC produced satisfactory seizure outcomes in LGS patients with different seizure types, including DAs. Even non-responders to prior CC responded to subsequent VNS for residual seizures, except for DAs. There is a greater likelihood that these procedures may be more feasible in patients who possess conversation ability prior to VNS.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan

    Masaya Katagiri, Koji Iida, Kota Kagawa, Akira Hashizume & Kaoru Kurisu

  2. Epilepsy Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan

    Masaya Katagiri, Koji Iida, Kota Kagawa, Akira Hashizume & Nobutsune Ishikawa

  3. Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan

    Nobutsune Ishikawa

  4. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan

    Ryosuke Hanaya & Kazunori Arita

Authors
  1. Masaya Katagiri
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  2. Koji Iida
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  3. Kota Kagawa
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  4. Akira Hashizume
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  5. Nobutsune Ishikawa
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  6. Ryosuke Hanaya
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  7. Kazunori Arita
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  8. Kaoru Kurisu
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Corresponding author

Correspondence to Koji Iida.

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Funding

No funding was received for this research.

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None.

Ethical approval

This study was approved by the Ethical Committee for Epidemiology of Hiroshima University. All procedures performed in this study were in accordance with the 1964 Helsinki Declaration.

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For this type of study formal consent is not required.

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Katagiri, M., Iida, K., Kagawa, K. et al. Combined surgical intervention with vagus nerve stimulation following corpus callosotomy in patients with Lennox-Gastaut syndrome. Acta Neurochir 158, 1005–1012 (2016). https://doi.org/10.1007/s00701-016-2765-9

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  • DOI: https://doi.org/10.1007/s00701-016-2765-9

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