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

Jennifer Hong Section of Neurosurgery, Department of Surgery,

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Atman Desai Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California

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Vijay M. Thadani Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and

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David W. Roberts Section of Neurosurgery, Department of Surgery,
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and

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OBJECTIVE

Vagal 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.

METHODS

The 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.

RESULTS

Ten 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.

CONCLUSIONS

The authors demonstrate that CC can help reduce seizures in patients with medically refractory epilepsy following VNS, particularly with respect to drop attacks.

ABBREVIATIONS

CC = corpus callosotomy; CPS = complex partial seizures; DRE = drug-resistant epilepsy; EEG = electroencephalography; GTC = generalized tonic-clonic; LGS = Lennox-Gastaut syndrome; LITT = laser interstitial thermal therapy; SPS = simple partial seizures; SRS = stereotactic radiosurgery; VNS = vagal nerve stimulation.
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