Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox–Gastaut syndrome

Lin, Ji-Ho; Kwan, Shang‐Yeong

doi:10.1016/j.jocn.2011.04.044

Cited by 10 publications

(13 citation statements)

References 18 publications

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“…Two-proportion z-tests revealed no significant differences between seizure reduction at 0-6 months and 6 months-2 years (p = .had seizure reduction data for the 6-month-2-year postprocedure period, with 103 of 152 (67.7%, 95% CI = 60.0%-75.4%) patients experiencing a reduction in seizure frequency. Thirteen studies24,[35][36][37][38][40][41][42][43][44]48,50,51 had seizure reduction data for the 2+-year postprocedure period, with 193 of 291 (66.3%, 95% CI = 61.1%-71.5%) patients experiencing a reduction in seizure frequency. Two-proportion F I G U R E 2 Forest plot of last follow-up seizure reduction rate with the most data for vagus nerve stimulation studies.…”

mentioning

confidence: 99%

The role of surgery in the management of Lennox–Gastaut syndrome: A systematic review and meta‐analysis of the clinical evidence

Thirunavu

et al. 2021

Epilepsia

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Lennox–Gastaut syndrome (LGS) is a severe form of childhood onset epilepsy in which patients require multiple medications and may be candidates for palliative surgical intervention. In this meta‐analysis, we sought to evaluate the impact of palliative vagus nerve stimulation (VNS), corpus callosotomy (CC), and resective surgery (RS) by analyzing their impact on seizure control, antiepileptic drug (AED) usage, quality of life (QOL), behavior, cognition, prognostic factors, and complications. A systematic search of PubMed MEDLINE, Scopus, and Cochrane Database of Systematic Reviews was performed to find articles that met the following criteria: (1) prospective/retrospective study with original data, (2) at least one LGS surgery patient aged less than 18 years, and (3) information on seizure frequency reduction (measured as percentage, Engel class, or qualitative comment). Seizures were analyzed quantitatively in a meta‐analysis of proportions and a random‐effects model, whereas other outcomes were analyzed qualitatively. Forty studies with 892 LGS patients met the selection criteria, with 19 reporting on CC, 17 on VNS, four on RS, two on RS + CC, one on CC + VNS, and one on deep brain stimulation. CC seizure reduction rate was 74.1% (95% confidence interval [CI] = 64.5%–83.7%), and VNS was 54.6% (95% CI = 42.9%–66.3%), which was significantly different (p < .001). RS seizure reduction was 88.9% (95% CI = 66.1%–99.7%). Many VNS patients reported alertness improvements, and most had no major complications. VNS was most effective for atonic/tonic seizures; higher stimulation settings correlated with better outcomes. CC patients reported moderate cognitive and QOL improvements; disconnection syndrome, transient weakness, and respiratory complications were noted. Greater callosotomy extent correlated with better outcomes. AED usage most often did not change after surgery. RS showed considerable QOL improvements for patients with localized seizure foci. In the reported literature, CC appeared to be more effective than VNS for seizure reduction. VNS may provide a similar or higher level of QOL improvement with lower aggregate risk of complications. Patient selection, anatomy, and seizure type will inform decision‐making.

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confidence: 99%

The role of surgery in the management of Lennox–Gastaut syndrome: A systematic review and meta‐analysis of the clinical evidence

Thirunavu

et al. 2021

Epilepsia

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“…Drop attacks are the most disabling feature of LGS and are known to be caused by secondary bilateral synchrony. This rapid spread via the CC explains the efficacy of callosotomy in reducing drop attacks in LGS patients [1,[4][5][6][7][8][9][10].…”

Section: Discussion / обсуждениеmentioning

confidence: 96%

“…Several hypotheses regarding how callosotomy reduces seizure frequency have been proposed. The CC, through its rich connectivity between the hemispheres, enhances bilateral synchronization and generalization of IEDs and IDs [1,[4][5][6][7][8][9][10]. Callosotomy disconnects the pathways between homologous areas of two hemispheres, disrupting the synchronized IEDS and IDs and revealing the primary focus (focal discharges) [4][5][6].…”

Section: Discussion / обсуждениеmentioning

confidence: 99%

Reiterating the role of corpus callosum in generalization of interictal and ictal epileptiform discharges: a case report with post-callosotomy intracranial electroencephalography in Lennox–Gastaut syndrome

Gopinath

Pillai

Diwan

et al. 2021

Èpilepsiâ paroksizmalʹnye sostoâ.

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Lennox–Gastaut syndrome (LGS) is an epileptic encephalopathy characterized by delayed mental development and intractable multiple seizure types, predominantly tonic. Drop attacks are the commonest and the most disabling type of seizures. Resective surgery is often not possible in LGS as the electroencephalogram (EEG) abnormalities are usually multifocal and generalized, and magnetic resonance image is often either normal or multilesional. We report a case of LGS with bilateral parieto-occipital gliosis where EEG before and after callosotomy demonstrated synchronized bilateral interictal epileptiform discharges and ictal discharges becoming desynchronized and running down. This phenomenon emphasizes the role of the corpus callosum in secondary bilateral synchrony.

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“…Patients undergoing callosotomy are typically limited to those with catastrophic, drug-resistant, intractable epilepsy and moderate-to-severe intellectual disability. 14,20,25 Callosotomy is considered particularly helpful for atonic, tonic, and tonic-clonic seizures. 14,20 Callosotomy is often targeted at resolving "drop" attacks in children with LGS.…”

Section: Patient Selectionmentioning

confidence: 99%

Surgical options for patients with Lennox‐Gastaut syndrome

Douglass

Salpekar

2014

Epilepsia

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SUMMARYDespite ongoing investigation into pharmacologic treatments for Lennox-Gastaut syndrome (LGS), outcomes for chronic administration of medications remain disappointing. In many instances LGS is treatment refractory, resulting in poor prognoses that include intellectual disability, persisting seizures, and psychiatric conditions. For patients with treatment resistance to other modalities for LGS, a further option is surgical intervention. Evaluation for surgery should involve interictal electroencephalogram (EEG), magnetic resonance imaging (MRI) analysis, and age-appropriate neuropsychological/developmental assessment. Resective surgery, where seizure foci are removed, successfully controls seizures in many cases, particularly where lesionectomy or lobar resections are appropriate. Recent studies of resective surgery on individuals with LGS show promising results, with a high percentage of patients having improved seizure control. Corpus callosotomy is a palliative surgical approach that aims at controlling potentially injurious seizures, for example, atonic or drop seizures, by preventing the bilateral spread of epileptic activity. Once associated with a high risk for morbidity and mortality, microsurgical techniques and surgery limited to the anterior region of the callosum have greatly diminished complications of corpus callosotomy surgery. Vagus nerve stimulation, another palliative procedure, offers rates of seizure improvement similar to those of corpus callosotomy, with the exception of atonic seizure for which corpus callosotomy may lead to a greater reduction. Recent advances in surgical techniques offer encouraging options for treatment of LGS.

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Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox–Gastaut syndrome

Cited by 10 publications

References 18 publications

The role of surgery in the management of Lennox–Gastaut syndrome: A systematic review and meta‐analysis of the clinical evidence

The role of surgery in the management of Lennox–Gastaut syndrome: A systematic review and meta‐analysis of the clinical evidence

Reiterating the role of corpus callosum in generalization of interictal and ictal epileptiform discharges: a case report with post-callosotomy intracranial electroencephalography in Lennox–Gastaut syndrome

Surgical options for patients with Lennox‐Gastaut syndrome

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