HOW MANY PALLIATIVE SURGICAL PROCEDURES FOR INTRACTABLE EPILEPSY?
Abstract number :
1.459
Submission category :
Year :
2003
Submission ID :
1169
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Frank J. Ritter, Michael D. Frost, Willie T. Anderson, Mary E. Dunn, Patricia E. Penovich, John R. Gates Minnesota Epilepsy Group, PA of United Hospital and Children[apos]s Hospital and Clinics-St Paul, St. Paul, MN; Department of Neurology, University of
Rarely are seizures completely controlled by either corpus callosotomy (CC) or vagal nerve stimulation (VNS). If a patient has had one of these procedures, helpful or not, will the other procedure be of benefit? We reviewed our experience with patients who had both procedures to answer the following questions: Were seizures decreased by either palliative procedure, or by both? Were the number of antiepileptic medications (AEMs) taken by the patient decreased after either procedure? To which therapeutic intervention was seizure frequency reduction attributed? Was there a subjective improvement in the patient[apos]s quality of life (QOL)?
Records of surgical patients were searched to find those who had both CC and VNS. The medical records were reviewed for demographics, seizure type/s, medication/s, and seizure frequency before and after surgeries. A seizure frequency decrease of 80% or more was considered a positive outcome following CC. A decrease of seizures of 50% or more following VNS was considered positive.
20 patients (13 male/7 female) had both CC [amp] VNS surgeries. 18/20 (90%) had Lennox-Gastaut syndrome (LGS) with multiple seizure types [amp] 2 had partial secondarily generalized seizures. Prior to their last surgery they had failed an average 11 AEMs [amp] 50% had failed the ketogenic diet. 14/20 (70%) had a partial (4) or complete (10) CC prior to VNS. 7/14 had a positive response to CC prior to VNS. In 6/14 (42%) the VNS reduced seizures by [gt]50%. 4/6 VNS responders had a positive response to previous CC, 2 did not. Following the VNS, 4 patients had an increase in the number of AEMs, 1 decrease [amp] 9 unchanged. 6/20 (30%) had VNS prior to CC. All had LGS [amp] none had a positive response to VNS. All 6 had a positive response to CC, 2 partial CC, 4 complete CC, 3 had number of AEMs increased, 2 decreased [amp] 1 no change. 14/20 patients (or parents/care giver), reported an improvement in QOL after the second surgical procedure. In 2 patients the improvement in seizure control and QOL was attributed solely to a change in AEMs. The rest attributed these improvements to both surgeries or the most recent procedure.
In this refractory group of patients, 90% with LGS, over 50% appeared to benefit from a second palliative surgical procedure. Only rarely were AEMs reduced, but a subjective improvement was noted in QOL.