Efficacy and safety of corpus callosotomy after vagal nerve stimulation in patients with drug-resistant epilepsy

2018 ◽  
Vol 128 (1) ◽  
pp. 277-286 ◽  
Author(s):  
Jennifer Hong ◽  
Atman Desai ◽  
Vijay M. Thadani ◽  
David W. Roberts
Keyword(s):  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Case Series ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Class Iii ◽  
Corpus Callosotomy ◽  
Few Data ◽  
Medically Refractory Epilepsy

OBJECTIVEVagal nerve stimulation (VNS) and corpus callosotomy (CC) have both been shown to be of benefit in the treatment of medically refractory epilepsy. Recent case series have reviewed the efficacy of VNS in patients who have undergone CC, with encouraging results. There are few data, however, on the use of CC following VNS therapy.METHODSThe records of all patients at the authors' center who underwent CC following VNS between 1998 and 2015 were reviewed. Patient baseline characteristics, operative details, and postoperative outcomes were analyzed.RESULTSTen patients met inclusion criteria. The median follow-up was 72 months, with a minimum follow-up of 12 months (range 12–109 months). The mean time between VNS and CC was 53.7 months. The most common reason for CC was progression of seizures after VNS. Seven patients had anterior CC, and 3 patients returned to the operating room for a completion of the procedure. All patients had a decrease in the rate of falls and drop seizures; 7 patients experienced elimination of drop seizures. Nine patients had an Engel Class III outcome, and 1 patient had a Class IV outcome. There were 3 immediate postoperative complications and 1 delayed complication. One patient developed pneumonia, 1 developed transient mutism, and 1 had persistent weakness in the nondominant foot. One patient presented with a wound infection.CONCLUSIONSThe authors demonstrate that CC can help reduce seizures in patients with medically refractory epilepsy following VNS, particularly with respect to drop attacks.

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

2012 ◽  
Vol 32 (3) ◽  
pp. E12 ◽  
Author(s):  
David E. Connor ◽  
Menarvia Nixon ◽  
Anil Nanda ◽  
Bharat Guthikonda
Keyword(s):  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Epileptiform Activity ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Class I ◽  
Class Iii ◽  
Surgical Evaluation ◽  
Pediatric Populations ◽  
Medically Refractory Epilepsy

Object The authors conducted a study to evaluate the published results of vagal nerve stimulation (VNS) for medically refractory seizures according to evidence-based criteria. Methods The authors performed a review of available literature published between 1980 and 2010. Inclusion criteria for articles included more than 10 patients evaluated, average follow-up of 1 or more years, inclusion of medically refractory epilepsy, and consistent preoperative surgical evaluation. Articles were divided into 4 classes of evidence according to criteria established by the American Academy of Neurology. Results A total of 70 publications were reviewed, of which 20 were selected for review based on inclusion and exclusion criteria. There were 2 articles that provided Class I evidence, 7 that met criteria for Class II evidence, and 11 that provided Class III evidence. The majority of evidence supports VNS usage in partial epilepsy with a seizure reduction of 50% or more in the majority of cases and freedom from seizure in 6%–27% of patients who responded to stimulation. High stimulation with a gradual increase in VNS stimulation over the first 6 weeks to 3 months postoperatively is well supported by Class I and II data. Predictors of positive response included absence of bilateral interictal epileptiform activity and cortical malformations. Conclusions Vagal nerve stimulation is a safe and effective alternative for adult and pediatric populations with epilepsy refractory to medical and other surgical management.

Vagal nerve stimulation for medically refractory epilepsy in Angelman syndrome: a series of three cases

2018 ◽  
Vol 34 (3) ◽  
pp. 395-400
Author(s):  
Krystal L. Tomei ◽  
Christine Y. Mau ◽  
Michael Ghali ◽  
Jayoung Pak ◽  
Ira M. Goldstein
Keyword(s):  
Nerve Stimulation ◽  
Angelman Syndrome ◽  
Refractory Epilepsy ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Medically Refractory Epilepsy

781 Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

Neurosurgery ◽  
2000 ◽  
Vol 47 (2) ◽  
pp. 522-523
Author(s):  
Ravish V. Patwardhan ◽  
Martina Bebin ◽  
Jan Mathisen ◽  
Paul A. Grabb
Keyword(s):  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Medically Refractory Epilepsy

scholarly journals The long-term outcome of children with refractory epilepsy after a vagal nerve stimulator implantation: CHU Sainte-Justine experience

2015 ◽  
Vol 42 (S1) ◽  
pp. S7-S7
Author(s):  
ML Kaseka ◽  
LS Carmant ◽  
E Desplats ◽  
L Crevier ◽  
P Major ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Hospitalization Rate ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Nerve Stimulator ◽  
Vagal Nerve Stimulator ◽  
The Impact

Background: Debate persists in Canada about the cost and benefit of vagal nerve stimulation in patients with refractory epilepsy. The aim of our study was to evaluate the impact of a vagal nerve stimulator on the seizure frequency and the admission rate of children with refractory epilepsies over five years of follow-up. Methods: 52 patients were implanted between 2000-2013. Of these, 37 were followed at CHU Sainte-Justine and 21 kept seizure diaries. Seizure frequency was compared to the baseline at 6 months, 12 months, 24 months and 60 months of follow up using a multivariate ANOVA analysis. The hospitalization rate was calculated as the mean difference between the number of hospitalizations prior to and after the implantation. Results: Seizure frequency decreased by 58% at 6 months, by 61% at 12 months, by 53% at 24 months and by 63% at 60 months of follow up respectively compared to the baseline (p<0.001). The hospitalization rate decreased by 50.87% after surgery (p<0.001). Conclusion: In our population, vagal nerve stimulation has a sustained impact on seizure frequency and hospitalization rates. This supports previous data from our group and others on cost-effectiveness of the technique in children with refractory epilepsy.

Efficacy of Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1353-1358 ◽  
Author(s):  
Ravish V. Patwardhan ◽  
Benjamin Stong ◽  
E. Martina Bebin ◽  
Jan Mathisen ◽  
Paul A. Grabb
Keyword(s):  
Quality Of Life ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Vagal Nerve ◽  
Seizure Type ◽  
Seizure Reduction ◽  
Medically Refractory Epilepsy

ABSTRACT OBJECTIVE The effects of vagal nerve stimulation (VNS) on seizure frequency and quality of life were analyzed retrospectively in children with medically refractory epilepsy. METHODS Thirty-eight children aged 11 months to 16 years underwent implantation of vagal nerve stimulators. Age of seizure onset, duration of epilepsy, and seizure type and frequency were recorded preoperatively. Age at implantation, length of follow-up, seizure type and frequency, and change in quality of life (QOL) were recorded postoperatively. Changes in QOL were assigned a QOL score by the caretakers on a visual analog scale of −1 (much worse) to +1 (much improved). RESULTS The median follow-up period was 12 months (range, 10–18 mo). Eleven (29%), 15 (39%), 5 (13%), and 7 (18%) children had greater than 90% reduction, 50 to 90% reduction, less than 50% reduction, and no reduction in seizure frequency, respectively. For all children, seizure reduction by seizure type was as follows: atonic (80%), absence (65%), complex partial (48%), and generalized tonicoclonic (45%). The mean change in QOL score was 0.61. Eighty-six percent of the children had QOL scores of 0.5 (improved) or higher. Follow-up of at least 6 months was associated with greater seizure reduction (P = 0.05) and higher QOL score (P &lt; 0.01). Seizure reduction was greater in children with onset of epilepsy after 1 year of age (P &lt; 0.05). The age of the child and duration of epilepsy were not associated with greater or lesser degrees of seizure reduction. CONCLUSION VNS provided improvements in seizure control for the majority of children regardless of age. QOL was improved in the majority of children with VNS. VNS should be considered for children with medically refractory epilepsy who have no surgically resectable focus.

scholarly journals Corpus callosotomy performed with laser interstitial thermal therapy

2019 ◽  
pp. 1-9 ◽  
Author(s):  
Jarod L. Roland ◽  
Syed Hassan A. Akbari ◽  
Afshin Salehi ◽  
Matthew D. Smyth
Keyword(s):  
Refractory Epilepsy ◽  
Effective Means ◽  
Thermal Therapy ◽  
Class Iii ◽  
Corpus Callosotomy ◽  
Invasive Approach ◽  
Laser Interstitial Thermal Therapy ◽  
Less Invasive ◽  
Medically Refractory Epilepsy

OBJECTIVECorpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for corpus callosotomy.METHODSThe authors retrospectively reviewed all patients treated for medically refractory epilepsy by corpus callosotomy, either partial or completion, with LITT. Chart records were analyzed to summarize procedural metrics, length of stay, adverse events, seizure outcomes, and time to follow-up. In select cases, resting-state functional MRI was performed to qualitatively support effective functional disconnection of the cerebral hemispheres.RESULTSTen patients underwent 11 LITT procedures. Five patients received an anterior two-thirds LITT callosotomy as their first procedure. One patient returned after LITT partial callosotomy for completion of callosotomy by LITT. The median hospital stay was 2 days (IQR 1.5–3 days), and the mean follow-up time was 1.0 year (range 1 month to 2.86 years). Functional outcomes are similar to those of open callosotomy, with the greatest effect in patients with a significant component of drop attacks in their seizure semiology. One patient achieved an Engel class II outcome after anterior two-thirds callosotomy resulting in only rare seizures at the 18-month follow-up. Four others were in Engel class III and 5 were Engel class IV. Hemorrhage occurred in 1 patient at the time of removal of the laser fiber, which was placed through the bone flap of a prior open partial callosotomy.CONCLUSIONSLITT appears to be a safe and effective means for performing corpus callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for corpus callosotomy.

Efficacy of Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1353-1358 ◽  
Author(s):  
Ravish V. Patwardhan ◽  
Benjamin Stong ◽  
E. Martina Bebin ◽  
Jan Mathisen ◽  
Paul A. Grabb
Keyword(s):  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Medically Refractory Epilepsy

scholarly journals Refractory Generalized Seizures: Response to Corpus Callosotomy and Vagal Nerve Stimulation

Epilepsia ◽  
2006 ◽  
Vol 47 (1) ◽  
pp. 115-122 ◽  
Author(s):  
Maromi Nei ◽  
Michael O'Connor ◽  
Joyce Liporace ◽  
Michael R. Sperling
Keyword(s):  
Nerve Stimulation ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Corpus Callosotomy ◽  
Generalized Seizures
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