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Resective surgery combined with corpus callosotomy for children with non-focal lesional Lennox–Gastaut syndrome

  • Clinical Article - Functional
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Abstract

Background

The first prospective trial for resective surgery combined with corpus callosotomy (CCT) was performed to investigate the outcomes of the combined surgery in children with Lennox–Gastaut syndrome (LGS) without focal lesion on brain MRI.

Methods

This study enrolled 68 children with LGS and without focal lesion on brain MRI, of which 25 received medicine (medicine group) and 43 underwent surgery (surgery group), including 20 with exclusively resective surgery (exclusively resection subgroup) and 23 with resective surgery combined with CCT (combined CCT subgroup). All patients were followed for 3–5 years.

Results

Significant differences in seizure control were observed between the medicine group and the exclusively resection subgroup and combined CCT subgroup at the 1-year, 3-year, and 5-year follow-ups. There was a trend that the children with resection combined with CCT had better seizure control than those with exclusively resection at the three follow-ups, but this could not be verified by the statistical method used. Furthermore, significant differences were not observed in seizure control between children with different MRI findings, age at surgery, or pathology in the surgery group. The percentage of long-term seizure-free did not remain as high as the percentage of early stage seizure-free at 1-year follow-up. However, the children with combined CCT surgery demonstrated more postoperative improvement than the children with resective surgery alone based on the mean QOL score (10.78 vs. 5.75, p = 0.0152) and full-scale IQ (7.91 vs. 4.55, p = 0.0446).

Conclusions

Resective surgery combined with CCT can provide favorable seizure control and obvious improvements in QOL and IQ in children with LGS. This combined approach can be performed in carefully selected LGS children without focal lesions and can localize the epileptogenic zone following a comprehensive preoperative evaluation.

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Acknowledgments

The authors are grateful to the patients and their families for their long-term cooperation. We also appreciate the contribution provided by the following persons: Dr. HB Kong, XP Wang, from the Neurosurgery Department; and Dr. SS Liang, Dr. N. Liu and all technicians in the Neurophysiologic Laboratory of Capital Epilepsy Therapy Center.

Author information

Authors and Affiliations

  1. Neurosurgery Department, PLA General Hospital, Beijing, China, 100853

    Ping Ding & Shuli Liang

  2. Neurosurgery Department, First Affiliated Hospital of PLA General Hospital, No. 51, Fucheng Road, Beijing, 100048, China

    Ping Ding, Shuli Liang, Shaohui Zhang & Xiaoman Yu

  3. Neurosurgery Department, Affiliated Hospital of Jining Medical College, Jining, China, 272000

    Junchen Zhang

  4. Paediatric Department, First Affiliated Hospital of PLA General Hospital, No. 51, Fucheng Road, Beijing, 100048, China

    Xiaohong Hu

Authors
  1. Ping Ding
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  2. Shuli Liang
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  3. Shaohui Zhang
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  4. Junchen Zhang
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  5. Xiaohong Hu
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  6. Xiaoman Yu
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Corresponding author

Correspondence to Shuli Liang.

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Conflict of interest

None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Funding

This research was funded by Beijing Technology & Science Nova Training Project (2010B084).

Ethical approval

This study was specifically approved by the Institutional Ethics Committee of First Affiliated Hospital of Chinese People’s Liberation Army General Hospital, and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients provided written informed consent prior to treatments.

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Comments

The authors present an impressive work in a prospective series of Lennox–Gastaut patients. They report on patients included from March 2004 to October 2009. They focus on the surgical group, finally including 43 patients. They were divided into one group of 20 children who underwent a focal resection determined by the presurgical epilepsy work-up, and another group of 23 children that in addition to the focal resection also underwent an anterior corpus callosotomy. They also report on 25 patients who were exclusively treated by AED, however not fully comparable with the surgical group. Even if they do not find statistically verifiable differences they report on a trend of better seizure outcomes in the combined group. They report for the total (n = 43) surgical group of patients rather good (regarding the Lennox–Gastaut syndrome) seizure outcomes; 69.8 % at 1 year, 60.5 % at 3 years, and 54.5 % at 5-year follow-up. The AED exclusive group had corresponding figures of 1, 0, and 0 %. However, the combined surgery group did perform better in full-scale IQ and overall QOL compared to the focal resection-only group. They also give individual details for each patient. This is a valuable addition to the literature, and it represents a work that is demanding, and requires a large epilepsy surgery program.

Bertil Rydenhag

Gothenburg, Sweden

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Ding, P., Liang, S., Zhang, S. et al. Resective surgery combined with corpus callosotomy for children with non-focal lesional Lennox–Gastaut syndrome. Acta Neurochir 158, 2177–2184 (2016). https://doi.org/10.1007/s00701-016-2947-5

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  • DOI: https://doi.org/10.1007/s00701-016-2947-5

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