Acta Neurochirurgica

, Volume 158, Issue 5, pp 1005–1012 | Cite as

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

  • Masaya Katagiri
  • Koji IidaEmail author
  • Kota Kagawa
  • Akira Hashizume
  • Nobutsune Ishikawa
  • Ryosuke Hanaya
  • Kazunori Arita
  • Kaoru Kurisu
Clinical Article - Functional



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.


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.


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).


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.


Lennox-Gastaut syndrome Vagus nerve stimulation Corpus callosotomy Surgical outcome Combination surgical therapy 


Compliance with ethical standards


No funding was received for this research.

Conflict of interest


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.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Camfield PR (2011) Definition and natural history of Lennox-Gastaut syndrome. Epilepsia 52(Suppl 5):3–9CrossRefPubMedGoogle Scholar
  2. 2.
    Engel J, Pedley TA, Aicardi J, Dichter MA, Moshe S (eds) (2008) Epilepsy: a comprehensive textbook, vol 3. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  3. 3.
    Vanstraten AF, Mbbs YN (2012) Pediatric neurology update on the management of Lennox-Gastaut syndrome. Pediatr Neurol 47(3):153–161CrossRefPubMedGoogle Scholar
  4. 4.
    Kostov K, Kostov H, Taubøll E (2009) Epilepsy & behavior long-term vagus nerve stimulation in the treatment of Lennox-Gastaut syndrome. Epilepsy Behav 16(2):321–324CrossRefPubMedGoogle Scholar
  5. 5.
    Lin J-H, Kwan S-Y (2012) Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox-Gastaut syndrome. J Clin Neurosci 19(3):388–393CrossRefPubMedGoogle Scholar
  6. 6.
    Sunaga S, Shimizu H, Sugano H (2009) Long-term follow-up of seizure outcomes after corpus callosotomy. Seizure 18(2):124–128CrossRefPubMedGoogle Scholar
  7. 7.
    Cross JH, Jayakar P, Nordli D, Delalande O, Duchowny M, Wieser HG, Guerrini R, Mathern GW (2006) Proposed criteria for referral and evaluation of children for epilepsy surgery: recommendations of the subcommission for pediatric epilepsy surgery. Epilepsia 47(6):952–959CrossRefPubMedGoogle Scholar
  8. 8.
    Lancman G, Virk M, Shao H, Mazumdar M, Greenfield JP, Weinstein S, Schwartz TH (2012) Vagus nerve stimulation vs. corpus callosotomy in the treatment of Lennox-Gastaut syndrome: A meta-analysis. Seizure Eur J Epilepsy 6–11Google Scholar
  9. 9.
    Ben-Menachem E, Hellström K, Waldton C, Augustinsson LE (1999) Evaluation of refractory epilepsy treated with vagus nerve stimulation for up to 5 years. Neurology 52(6):1265–1267CrossRefPubMedGoogle Scholar
  10. 10.
    Frost M, Gates J, Helmers SL, Wheless JW, Levisohn P, Tardo C, Conry JA (2001) Vagus nerve stimulation in children with refractory seizures associated with Lennox-Gastaut syndrome. Epilepsia 42(9):1148–1152CrossRefPubMedGoogle Scholar
  11. 11.
    Hornig GW, Murphy JV, Schallert G, Tilton C (1997) Left vagus nerve stimulation in children with refractory epilepsy: an update. South Med J 90(5):484–488CrossRefPubMedGoogle Scholar
  12. 12.
    Karceski S (2001) Vagus nerve stimulation and Lennox-Gastaut syndrome: a review of the literature and data from the VNS patient registry. CNS Spectr 6(9):766–770PubMedGoogle Scholar
  13. 13.
    Lundgren J, Amark P, Blennow G, Strömblad LG, Wallstedt L (1998) Vagus nerve stimulation in 16 children with refractory epilepsy. Epilepsia 39(8):809–813CrossRefPubMedGoogle Scholar
  14. 14.
    Guillamón E, Miró J, Gutiérrez A, Conde R, Falip M, Jaraba S, Plans G, Garcés M, Villanueva V (2014) Combination of corpus callosotomy and vagus nerve stimulation in the treatment of refractory epilepsy. Eur Neurol 71(1-2):65–74PubMedGoogle Scholar
  15. 15.
    McHugh JC, Singh HW, Phillips J, Murphy K, Doherty CP, Delanty N (2007) Outcome measurement after vagal nerve stimulation therapy: proposal of a new classification. Epilepsia 48(2):375–378CrossRefPubMedGoogle Scholar
  16. 16.
    Spencer SS, Spencer DD, Glaser GH, Williamson PD, Mattson RH (1984) More intense focal seizure types after callosal section: the role of inhibition. Ann Neurol 16(6):686–693CrossRefPubMedGoogle Scholar
  17. 17.
    Cukiert A, Cukiert CM, Burattini JA, Lima AM, Forster CR, Baise C, Argentoni-Baldochi M (2013) Long-term outcome after callosotomy or vagus nerve stimulation in consecutive prospective cohorts of children with Lennox-Gastaut or Lennox-like syndrome and non-specific MRI findings. Seizure 22(5):396–400CrossRefPubMedGoogle Scholar
  18. 18.
    Buoni S, Zannolli R, Macucci F, Pieri S, Galluzzi P, Mariottini A, Fois A (2004) Delayed response of seizures with vagus nerve stimulation in Lennox-Gastaut syndrome. Neurology 63(8):1539–1540CrossRefPubMedGoogle Scholar
  19. 19.
    Binnie CD, Polkey CE (2000) Commission on Neurosurgery of the International League Against Epilepsy (ILAE) 1993-1997: recommended standards. Epilepsia 41(10):1346–1349CrossRefPubMedGoogle Scholar
  20. 20.
    Spencer SS, Katz A, Ebersole J, Novotny E, Mattson R (1993) Ictal EEG changes with corpus callosum section. Epilepsia 34(3):568–573CrossRefPubMedGoogle Scholar
  21. 21.
    Hur YJ, Kang H-C, Kim DS, Choi SR, Kim HD, Lee JS (2011) Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy. Brain Dev 33(8):672–677CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Masaya Katagiri
    • 1
    • 2
  • Koji Iida
    • 1
    • 2
    Email author
  • Kota Kagawa
    • 1
    • 2
  • Akira Hashizume
    • 1
    • 2
  • Nobutsune Ishikawa
    • 2
    • 3
  • Ryosuke Hanaya
    • 4
  • Kazunori Arita
    • 4
  • Kaoru Kurisu
    • 1
  1. 1.Department of Neurosurgery, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshima CityJapan
  2. 2.Epilepsy CenterHiroshima University HospitalHiroshima CityJapan
  3. 3.Department of Pediatrics, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshima CityJapan
  4. 4.Department of Neurosurgery, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan

Personalised recommendations