Abstracts

Rationale: In children with pharmacoresistent epilepsy, research supports the use of vagal nerve stimulator implantation (VNS), corpus callosotomy (CC), and/or the ketogenic diet (KD) for palliative therapy. However, few studies have compared the efficacy of these treatment modalities in a single cohort study. We investigated (1) seizure control; (2) cognitive and behavioral outcomes; (3) parent satisfaction; (4) improvements in quality of life; and (5) predictors of quality of life and parent satisfaction. Methods: 336 Patients were identified as having VNS, CC or KD between January 2010 and November 2015. Parents of 210 patients, who had 292 (VNS, n=150; CC, n=44; KD, n=98) treatment modalities, agreed to participate in a phone interview. 60% were male with ages ranging from 8 months to 20 years. Seizure control, cognitive and behavioral factors, quality of life and treatment satisfaction was rated via a 9-item telephone questionnaire. Parent responses were counted and converted to proportion scores. Logistic regression was used to explore the determinants of improved quality of life and parental satisfaction across intervention type. Results: Improvement for each group across four cognitive and behavioral domains ranged from: VNS, 33.3-49.3%; CC, 40.9-59.1%; KD, 34.7-57.1%. Greater than or equal to 50% reduction in atonic and/or other generalized seizures occurred in 51.7% of VNS, 53.5%of CC, and 62.5% of KD groups. Injury reduction of ≥50% was observed in 51.7% of VNS, 53.5%of CC, and 62.5% of KD groups. Focal seizure reduction of ≥50% was documented in 52.9% of VNS, 55.8% of CC, and 56% of KD groups. Improvement in quality of life was reported in 43.9% of the VNS group, 62.5% of the CC group, and 48.4% of the KD group. Parents reported treatment satisfaction in 80% of the VNS group, 75% of the CC group, and 79.6% of the KD group. Improved child behavior, engagement, seizure frequency, and fewer injuries were associated with a 3-7 fold increase in parent rated improvements to child quality of life. Finally, improved child engagement as well as reduction in seizure frequency and injuries contributed to a 2-3 fold increase in parent satisfaction Conclusions: VNS, CC and KD was successful in reducing both generalized and focal seizure types, KD showing a trend towards slightly better success. The literature supports an even greater reduction of atonic seizures with CC, however the procedure also reduced focal seizure frequency and showed a trend towards improved QOL compared to VNS and KD. Reduction in injuries paralleled a reduction in atonic/generalized seizures. Improvements observed in cognitive and behavioral domains, better seizure control and less falls positively affected quality of life. Parent overall satisfaction was greater than 75%, which far outweighed seizure reduction or behavioral improvements. These findings support palliative management for those with pharmacoresistant epilepsy who are not candidates for surgical resection. Funding: Anderson Foundation