Corpus callosotomy may reduce seizures in LGS after failure of vagus nerve stimulation

For children with Lennox-Gastaut syndrome (LGS) who have not achieved seizure control with vagus nerve stimulation, corpus callosotomy appears to help reduce all seizure subtypes, as shown in a study.

The multinational, multicentre retrospective study included 127 children (median age at epilepsy onset, 6 months; boys, 63 percent ) with LGS who underwent corpus callosotomy at a median age of 11 years. All of them had prior vagus nerve stimulation (median age at surgery, 7 years), which failed to result in satisfactory seizure control.

Researchers obtained data on epilepsy characteristics, surgical details, epilepsy outcomes, and complications. The most common seizure type was drop attacks (tonic or atonic), which was documented in 102 patients. The primary endpoint was a reduction of 50 percent in drop attacks.

A total of 86 patients underwent a single-stage complete corpus callosotomy, whereas 41 had an anterior callosotomy. Ten patients who did not initially have a complete corpus callosotomy underwent a second surgery for completion of corpus callosotomy due to seizure persistence.

Surgical complications occurred in 18 out of 137 corpus callosotomy procedures (13 percent). The complications included wound, pneumonia, neurological events (ie, transient or pericallosal artery infarct), noninfectious fever, and plate removal, among others.

In terms of effect, corpus callosotomy resulted in at least a 50-percent reduction in drop attacks and other seizures in 83 percent and 60 percent of children, respectively. Permanent morbidity occurred in 1.5 percent of children. There were no deaths reported.