Abstracts

Rationale: Generalized medically resistant epilepsy remains a major burden in pediatric epilepsy. Surgical options are limited to palliative interventions of VNS (vagus nerve stimulator) implantation and corpus callosotomy(CC). Candidacy criteria for each intervention have never been critically and systematically evaluated and there exists a wide range of utilization of each procedure between experienced pediatric surgical centers. We review here our experience in a cohort of surgically treated patients with generalized epilepsy to discern relative contributions, risks and outcomes from each procedure. Methods: Pediatric patients undergoing surgical intervention (either VNS or CC) for generalized epilepsy were identified from our Pediatric Epilepsy Center database and retrospectively reviewed. All patients had at least 2 years of follow up. Data related to pre and post operative seizure type, pattern, frequency, burden of falls and injuries, severity of associated encephalopathy were summarized and tabulated. Uni-variate and multi-variate analysis was performed. Results: Between 2004 and 2010 23 patients underwent CC and 67 patients underwent VNS implantation.. For CC there were 17 complete callosotomies and 6 anterior 2/3rds callosotomies that resulted in seizure freedom in 4 patients (17%), elimination/marked reduction of drop events in 19 (83%) and 4 (12%) patients respectively and 2 transient neurologic deficits (8%). VNS resulted in a 76% reduction in drop events in 14 patients who had pre-operative drops, a 14% rate of marked reduction/elimination of seizures and a 65% rate of overall improvement in seizure control. Conclusions: Callosotomy and VNS implantation are both safe, effective interventions that may contribute toward improving outcomes in pediatric generalized epilepsy