Treatment Outcome of Vagus Nerve Stimulation And/or Corpus Callosotomy for Younger Patients with Severe Drug-resistant Epilepsy
Abstract number :
1.334
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204480
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Keisuke Ohtani, MD,PhD – Jichi Medical University; Akira Gomi, Dr – Jichi Medical University; Kenji Ibayashi, Dr – Jichi Medical Univerity; Yohei Ishishita, Dr – Jichi Medical University; Kensuke Kawai, prof – Jichi Mdedical University; Takeshi Nakajima, Dr – Jichi Medical University
Rationale: Resective epilepsy surgery (RES) is effective in controlling seizures and improving QOL both in adults and younger patients. However, RES is not indicated for all children with severe drug-resistant epilepsy (DRE). Vagus nerve stimulation (VNS) and corpus callosotomy (CC) are possible options for them. We report our outcomes of these treatments.
Methods: Between April 2016 and March 2022, 18 children and adolescents (1-19 years old; median, 10 years) with DRE were treated with VNS (n=17) and total CC (n=5). Three of the patients underwent CC followed by VNS, and one patient underwent VNS followed by CC. Etiology was genetic in 9, infectious in 1, and unknown in 8. Main seizure type was tonic in 9, astatic in 4, myoclonic in 2, and miscellaneous in others. Fourteen was severely disabled and totally dependent. Others were moderately or mildly disabled. For patients with astatic seizure, CC was recommended first. The median follow-up was 1386 days (range, 161-2161). Engel's and McHugh’s classifications were used for post-treatment seizure outcome.
Results: Engel’s Classes at the last follow-up after CC and/or VNS were I in 1, II in 1, III in 10, and IV in 5. Of 12 patients with VNS, responders (McHugh’s class Ⅰ and Ⅱ) were 8 (47%). The median VNS output current setting at the last follow-up was 1.875 mA (range, 0.25-2.5 mA). After CC, all patients were free from astatic seizures during the follow-up period (657-2161 days). One patient had a surgical site infection and had the device removed. One patient with Lennox-Gastaut syndrome died after 6 months of VNS at the age of 19. He was diagnosed as SUDEP. One patient with 2p-trisomy syndrome died of SUDEP at the age of 23, four years after VNS implantation. There were no factors that significantly affected postoperative seizure outcome in univariate analysis, but there was a trend toward the worse preoperative development in the more severely impaired cases.
Conclusions: VNS and/or CC achieved significant seizure reduction in approximately three-fourths of children and adolescents with severe DRE who were not suitable for RES. CC was highly effective for astatic seizure and VNS was effective in suppressing residual seizures after CC. It is controversial which of VNS and CC should be performed first, but the results of this study suggested that at least VNS and CC were both additively effective against seizures. The seizure suppression effect of VNS tended to be maintained in long-term periods._x000D_
Funding: None
Surgery