Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study

Jonathan Roth¹, Lottem Bergman¹, Alexander G Weil², Tristan Brunette-Clement², Howard L Weiner^{3

4}, Jeffrey M Treiber^{3

4}, Ben Shofty⁵, Arthur Cukiert⁶, Cristine Mella Cukiert⁷, Manjari Tripathi⁸, Poodipedi Sarat Chandra⁸, Robert J Bollo⁹, Hélio Rubens Machado¹⁰, Marcelo Volpon Santos¹¹, William D Gaillard¹², Chima O Oluigbo¹³, George M Ibrahim¹⁴, George I Jallo¹⁵, Nir Shimony^{16

17

18

19}, Brent R O'Neill²⁰, Marcelo Budke²¹, María Ángeles Pérez-Jiménez²², Francesco T Mangano²³, Masaki Iwasaki²⁴, Keiya Iijima²⁴, Jorge Gonzalez-Martinez²⁵, Kensuke Kawai²⁶, Yohei Ishishita²⁶, Samer K Elbabaa²⁷, Luis Bello-Espinosa²⁸, Aria Fallah²⁹, Cassia A B Maniquis²⁹, Ido Ben-Zvi^{30

31}, Martin Tisdall^{30

31}, Manas Panigrahi³², Sita Jayalakshmi³³, Jeffrey P Blount³⁴, Georg Dorfmüller³⁵, Christine Bulteau³⁶, Scellig S Stone³⁷, Jeffrey Bolton³⁸, Ashutosh Singhal³⁹, Mary Connolly⁴⁰, Daad Alsowat⁴¹, Faisal Alotaibi⁴¹, John Ragheb⁴², Shimrit Uliel-Sibony⁴³

Affiliations

¹ Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
² Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada.
³ Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
⁴ Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA.
⁵ Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁶ Department of Neurosurgery, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil.
⁷ Department of Neurology and Neurophysiology, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil.
⁸ Center of Excellence for Epilepsy and MEG, AIIMS, New Delhi, India.
⁹ Division of Pediatric Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA.
¹⁰ Division of Pediatric Neurosurgery, Center for Epilepsy Surgery in Children, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil.
¹¹ Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil.
¹² Department of Neurology, Children's National Medical Center, Washington, District of Columbia, USA.
¹³ Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.
¹⁴ Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
¹⁶ Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
¹⁷ Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
¹⁸ Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁰ Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA.
²¹ Department of Neurosurgery, Niño Jesus University Children's Hospital, Madrid, Spain.
²² Department of Neurophysiology, Niño Jesus University Children's Hospital, Madrid, Spain.
²³ Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁴ Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
²⁵ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
²⁶ Department of Neurosurgery, Jichi Medical University, Tochigi, Japan.
²⁷ Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA.
²⁸ Pediatric Neurology and Epilepsy, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA.
²⁹ Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
³⁰ Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
³¹ Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.
³² Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India.
³³ Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India.
³⁴ Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, Alabama, USA.
³⁵ Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France.
³⁶ University of Paris, MC2Lab, Boulogne-Billancourt, France.
³⁷ Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³⁸ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³⁹ Division of Pediatric Neurosurgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁴⁰ Comprehensive Epilepsy Program, BC Children's Hospital, Vancouver, British Columbia, Canada.
⁴¹ Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
⁴² Department of Surgery, Nicklaus Children's Hospital, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA.
⁴³ Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

PMID: 37823366
DOI: 10.1111/epi.17796

Multicenter Study

Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study

Jonathan Roth et al. Epilepsia. 2023 Dec.

. 2023 Dec;64(12):3205-3212.

doi: 10.1111/epi.17796. Epub 2023 Oct 20.

Authors

Affiliations

¹ Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
² Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada.
³ Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
⁴ Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA.
⁵ Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁶ Department of Neurosurgery, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil.
⁷ Department of Neurology and Neurophysiology, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil.
⁸ Center of Excellence for Epilepsy and MEG, AIIMS, New Delhi, India.
⁹ Division of Pediatric Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA.
¹⁰ Division of Pediatric Neurosurgery, Center for Epilepsy Surgery in Children, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil.
¹¹ Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil.
¹² Department of Neurology, Children's National Medical Center, Washington, District of Columbia, USA.
¹³ Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.
¹⁴ Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
¹⁶ Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
¹⁷ Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
¹⁸ Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁰ Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA.
²¹ Department of Neurosurgery, Niño Jesus University Children's Hospital, Madrid, Spain.
²² Department of Neurophysiology, Niño Jesus University Children's Hospital, Madrid, Spain.
²³ Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁴ Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
²⁵ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
²⁶ Department of Neurosurgery, Jichi Medical University, Tochigi, Japan.
²⁷ Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA.
²⁸ Pediatric Neurology and Epilepsy, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA.
²⁹ Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
³⁰ Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
³¹ Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.
³² Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India.
³³ Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India.
³⁴ Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, Alabama, USA.
³⁵ Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France.
³⁶ University of Paris, MC2Lab, Boulogne-Billancourt, France.
³⁷ Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³⁸ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³⁹ Division of Pediatric Neurosurgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁴⁰ Comprehensive Epilepsy Program, BC Children's Hospital, Vancouver, British Columbia, Canada.
⁴¹ Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
⁴² Department of Surgery, Nicklaus Children's Hospital, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA.
⁴³ Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

PMID: 37823366
DOI: 10.1111/epi.17796

Abstract

Objective: Lennox-Gastaut syndrome (LGS) is a severe form of epileptic encephalopathy, presenting during the first years of life, and is very resistant to treatment. Once medical therapy has failed, palliative surgeries such as vagus nerve stimulation (VNS) or corpus callosotomy (CC) are considered. Although CC is more effective than VNS as the primary neurosurgical treatment for LGS-associated drop attacks, there are limited data regarding the added value of CC following VNS. This study aimed to assess the effectiveness of CC preceded by VNS.

Methods: This multinational, multicenter retrospective study focuses on LGS children who underwent CC before the age of 18 years, following prior VNS, which failed to achieve satisfactory seizure control. Collected data included epilepsy characteristics, surgical details, epilepsy outcomes, and complications. The primary outcome of this study was a 50% reduction in drop attacks.

Results: A total of 127 cases were reviewed (80 males). The median age at epilepsy onset was 6 months (interquartile range [IQR] = 3.12-22.75). The median age at VNS surgery was 7 years (IQR = 4-10), and CC was performed at a median age of 11 years (IQR = 8.76-15). The dominant seizure type was drop attacks (tonic or atonic) in 102 patients. Eighty-six patients underwent a single-stage complete CC, and 41 an anterior callosotomy. Ten patients who did not initially have a complete CC underwent a second surgery for completion of CC due to seizure persistence. Overall, there was at least a 50% reduction in drop attacks and other seizures in 83% and 60%, respectively. Permanent morbidity occurred in 1.5%, with no mortality.

Significance: CC is vital in seizure control in children with LGS in whom VNS has failed. Surgical risks are low. A complete CC has a tendency toward better effectiveness than anterior CC for some seizure types.

Keywords: Lennox-Gastaut syndrome; corpus callosotomy; refractory epilepsy; vagus nerve stimulation.

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Conflict of interest statement

None of the authors has any conflict of interest to disclose.

References

REFERENCES

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Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study

Affiliations

Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study

Authors

Affiliations

Abstract

Conflict of interest statement

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical