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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目的：Lennox-Gastaut综合征（LGS）是一种严重的癫痫性脑病，在生命的最初几年里，并且对治疗非常有抵抗力。一旦药物治疗失败,考虑姑息性手术，例如迷走神经刺激（VNS）或骨体切开术（CC）。尽管CC作为LGS相关跌落发作的主要神经外科治疗比VNS更有效，关于VNS后CC的附加值的数据有限。本研究旨在评估VNS之前CC的有效性。
方法：这家跨国公司，多中心回顾性研究集中在18岁之前接受CC的LGS儿童，在之前的VNS之后，未能达到令人满意的癫痫发作控制。收集的数据包括癫痫特征，手术细节,癫痫结果,和并发症。这项研究的主要结果是液滴攻击减少了50%。
结果：共127例（男性80例）。癫痫发作的中位年龄为6个月（四分位距[IQR]=3.12-22.75）。VNS手术的中位年龄为7岁（IQR=4-10），CC的中位年龄为11岁（IQR=8.76-15）。102例患者的主要癫痫发作类型为滴落发作（强直或无张力）。86名患者接受了单阶段完全CC，和41前骨切开术。由于癫痫持续发作，最初没有完整CC的十名患者接受了第二次手术以完成CC。总的来说,下降攻击和其他癫痫发作至少减少了50％，分别为83％和60％，分别。永久发病率为1.5%，没有死亡率。
结论：CC对于VNS失败的LGS患儿的癫痫发作控制至关重要。手术风险很低。对于某些癫痫发作类型，完全CC具有比前CC更好的效果。
方法：这家跨国公司，多中心回顾性研究集中在18岁之前接受CC的LGS儿童，在之前的VNS之后，未能达到令人满意的癫痫发作控制。收集的数据包括癫痫特征，手术细节,癫痫结果,和并发症。这项研究的主要结果是液滴攻击减少了50%。
结果：共127例（男性80例）。癫痫发作的中位年龄为6个月（四分位距[IQR]=3.12-22.75）。VNS手术的中位年龄为7岁（IQR=4-10），CC的中位年龄为11岁（IQR=8.76-15）。102例患者的主要癫痫发作类型为滴落发作（强直或无张力）。86名患者接受了单阶段完全CC，和41前骨切开术。由于癫痫持续发作，最初没有完整CC的十名患者接受了第二次手术以完成CC。总的来说,下降攻击和其他癫痫发作至少减少了50％，分别为83％和60％，分别。永久发病率为1.5%，没有死亡率。
结论：CC对于VNS失败的LGS患儿的癫痫发作控制至关重要。手术风险很低。对于某些癫痫发作类型，完全CC具有比前CC更好的效果。
