Abstract
Objective: The effectiveness of vagus nerve stimulation (VNS) for residual seizures after corpus callosotomy (CC) has not yet been fully investigated. We hypothesized that seizure control would be improved by VNS after CC. The purpose of this study was to compare seizure frequency between patients with implantation of a VNS generator (post-VNS group) or without VNS (non-post-VNS group) following CC. Methods: We retrospectively reviewed patients who underwent CC between January 2009 and May 2019 in our institution. We evaluated proportions of ≥50% reduction in seizure frequency (responders) and seizure reduction rate 1 and 2 years after VNS. To investigate factors related to responders, uni- and multivariate logistic regression analyses were performed regarding age, number of anti-seizure medications (ASMs), addition of novel ASMs (levetiracetam, lacosamide or perampanel), and post-VNS or non-post-VNS status. Results: Thirteen post-VNS patients and 24 non-post-VNS patients were analyzed in this study. Responder rate at 1 year after VNS differed significantly between the post-VNS group (53.9%) and non-post-VNS group (12.5%, p = 0.017). Number of ASMs at the time of CC and post-VNS were significantly associated with responders in univariate analyses (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.13–0.88, p = 0.025 and OR 8.2, 95%CI 1.6–41.6, p = 0.011, respectively), whereas age, sex, seizure frequency, and addition of novel ASMs were not. In multivariate analysis, the presence of VNS procedures after CC was the only factor favorably associated with responder status (OR 82.2, 95%CI 1.55–4355.7, p = 0.03). Conclusions: VNS therapy after CC may increase the proportion of responders independent of the addition of novel ASMs.
Highlights
Palliative techniques such as corpus callosotomy (CC) and vagus nerve stimulation (VNS) can be considered for patients with drug-resistant epilepsy who are not candidates for resective surgery
VNS therapy after CC may increase the proportion of responders independent of the addition of novel anti-seizure medications (ASMs)
We reviewed age at epilepsy onset and at the time of CC, sex, epilepsy syndromes such as West syndrome or Lennox-Gastaut syndrome (LGS), number and type of ASMs at the time of CC and VNS therapy, seizure type at the time of CC, seizure frequency at the time of CC, extent of CC, and model of VNS
Summary
Palliative techniques such as corpus callosotomy (CC) and vagus nerve stimulation (VNS) can be considered for patients with drug-resistant epilepsy who are not candidates for resective surgery. CC is more likely to improve seizure frequency or severity than VNS, for drop attacks or epileptic spasms [9,10,11,12]. The selection of these two techniques appears to depend on seizure type, surgical risk, and the wishes of the patient and caregivers, no universally accepted indications have been determined.
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