Authors :
Presenting Author: Cheng Yen Kuo, MD – Mayo clinic, Rochester, Minnesota
Raunak Singh, MD – Mayo clinic, Rochester, Minnesota
Shelja Sharma, MD – Mayo clinic, Rochester, Minnesota
Ryan Nguyen, MD, MEng – Mayo Clinic
Keith Starnes, MD – Mayo Clinic, Rochester MN, USA.
Lily C. Wong-Kisiel, MD – Mayo Clinic, Rochester, MN, USA.
Nicholas Gregg, MD – Mayo clinic, Rochester, Minnesota
Jamie J Van Gompel, MD – Mayo Clinic, Rochester MN, USA.
Kai Miller, MD, PhD – Mayo Clinic
Gregory Worrel, MD,PhD – Mayo Clinics
Brian Lundstrom, MD PhD – Mayo clinic, Rochester, Minnesota
Rationale:
Lennox-Gastaut syndrome (LGS) is a childhood-onset epileptic encephalopathy characterized by multiple seizure types, drug-resistant, and neurodevelopmental impairment, with characteristic EEG findings. Vagus nerve stimulation (VNS) and deep brain stimulation (DBS) have both demonstrated effectiveness in reducing seizures in LGS. It remains unclear whether DBS provides superior seizure control compared to VNS. This study aimed to compare seizure outcomes between patients with LGS receiving VNS and DBS, and to evaluate the therapeutic value of DBS in VNS non-responders.
Methods:
We retrospectively analyzed patients with LGS who underwent VNS or DBS implantation at Mayo Clinic (Rochester, MN) between March 2006 and March 2024. Data collected included demographics, seizure types, history of infantile epilepsy, structural neuroimaging, prior treatments, device type and settings, and seizure frequencies at baseline and 12- and 24-months post-implantation. Between group comparisons were made using the Mann-Whitney U test, and within-group comparisons across time points were evaluated using the Wilcoxon signed-rank test.
Results:
A total of 39 patients (61.5% male) were included. The mean age at implantation was 18.7 years (SD: 12.1; range: 6–51), with a mean age at epilepsy onset of 4.3 years (SD: 4.7; range: 0–15.6). Infantile-onset seizures were reported in 58.9%, and 41.0% had structural brain abnormalities. Eighteen patients received VNS alone, five received DBS alone, and sixteen underwent DBS after VNS failure. Among DBS recipients, 16 received bilateral ANT+CM stimulation and five received bilateral ANT-only stimulation. At 12 months, median seizure reduction rates were 67% for the VNS group and 50% for the DBS group (p = 0.29). At 24 months, median reductions were 80% for VNS and 58% for DBS (p = 0.12), indicating no significant difference between the groups. Among VNS non-responders who subsequently received DBS, 43.8% achieved ≥50% seizure reduction. Compared to baseline, the median seizure reduction following DBS was 50% at 12 months (p < 0.0001) and 78% at 24 months (p = 0.0002). No significant difference was observed between 12- and 24-month seizure reduction rates (p = 0.30).
Conclusions:
In patient with LGS, VNS and DBS show similar seizure reduction effectiveness at 12- and 24-months post-implantation, however, in VNS non-responders, the addition of DBS provided meaningful benefit in nearly half of these patients.
Funding:
NINDS R01NS129622 supported B.N.L.