Atonic seizures in children: a meta-analysis comparing corpus callosotomy to vagus nerve stimulation

Abstract

Purpose Atonic seizures are associated with a particularly poor response to medical treatment. We performed a systematic review and meta-analysis to compare the efficacy of corpus callosotomy (CC) and vagus nerve stimulation (VNS) in the management of atonic seizures in the pediatric population. Methods A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations, focusing on atonic seizures, CC, and VNS in pediatric populations. Pertinent clinical data were extracted and analyzed. Pooled effects between groups were calculated as standardized error (SE) with 95% confidence intervals (CIs). To assess for statistical significance, the Z-test was performed, using the pooled effect size (ES) and 95% CI for each intervention. Results A total of 31 studies met the inclusion criteria, with 24 studies encompassing 425 children treated with CC and 7 studies encompassing 108 children treated with VNS. Twenty-four studies were included in a meta-analysis. There was a statistically significant difference in the primary outcome of atonic seizure control in favor of CC (overall effect size (ES) 0.73, 95% CI 0.69-0.77 for CC, ES 0.4, 95% CI 0.28-0.51 for VNS, p = 0.003). There was a higher rate of complications requiring reoperation in the CC cohort (6.6% vs. 3.8%) and a 14% rate of symptomatic disconnection syndrome. Conclusions While both techniques are safe, CC provides a much higher chance of effectively managing this morbid seizure type albeit with a higher risk of re-operation and disconnection syndrome.

One‐year cost‐effectiveness of callosotomy vs vagus nerve stimulation for drug‐resistant seizures in Lennox‐Gastaut Syndrome: A decision analytic model

“…Clinical outcomes and complication probabilities were obtained from recent systematic reviews that synthesize and compare CC and VNS literature. 8,15 Given that LGS patients have multiple seizure types, seizure reduction probabilities were considered as an average of seizure reduction from all seizure types. 8 Seizure freedom and >50% seizure reduction were considered as discrete probabilities; thus, rates of seizure freedom were subtracted from rates of >50% seizure reduction to calculate the probabilities of seizure freedom and >50% seizure reduction.…”

Neuromodulation for Refractory Epilepsy

“…However, a recent meta-analysis of 31 studies involving 533 children showed that callosotomy was more effective than VNS at a cost of greater adverse events, including twice as many reoperations and a 14% rate of symptomatic disconnection syndrome. 31 A recent meta-analysis reported 38 cases with refractory (RSE) or super-refractory (SRSE) status epilepticus, where limited or no alternative treatments was available, who were treated with VNS, including 28 whose status was controlled. However, RSE/SRSE ceased more than 10 days after implantation in half of these patients, calling into question the role of VNS in controlling status.…”

Long‐term follow‐up seizure outcomes after corpus callosotomy: A systematic review with meta‐analysis

“…There have been several systematic reviews and meta‐analyses of surgeries for DRE, but only two articles have focused on CC (Chan et al., 2018 ; Graham et al., 2016 ), while others have compared CC to other treatments, such as vagus nerve stimulation (VNS) and ketogenic diet (Rolston et al., 2015 ; Sharawat et al., 2021 ; Ye et al., 2021 ). Most reports exploring the surgical results of CC in patients with DRE arise from small case series.…”