Abstracts

Rationale: The treatment of patients with Lennox-Gastaut syndrome represent a challenge. These individuals often present with extremely refractory seizures and epileptic encephalopathy. Treatment options include conventional AEDs, cannabidiol, ketogenic diet, callosotomy, VNS and DBS. We present a series of patients with Lennox-Gastaut syndrome submitted to both VNS and DBS.  Methods: Eight patients with Lennox-Gastaut syndrome submitted to VNS and thalamic centro-median DBS were studied. All subjects (6 boys) were kids under 18 years (mean= 9.4 years). They were divided in Group I (those who received VNS first followed by DBS) and Group II (those who received DBS first and VNS afterwards). Relatives or caregivers kept a seizure diary. Subjects were considered responders to each therapy when at least a 50% reduction in the seizure frequency was noticed. Results: All subjects in both groups were considered good responders for their initial therapy; mean seizure frequency reduction for initial therapy was 72% and 69% for Group I and II, respectively. Three out of 4 subjects in both groups had additional seizure frequency reduction and were considered responders to the second therapy in both Group I and II; mean seizure frequency reduction for the second therapy was 78% and 56% for Group I and II, respectively.  Conclusions: The concomitant use of VNS and DBS may lead to incremental seizure control, without any significant additional side effects. It is not clear at this point which procedure should be used first. Funding: No funding