Abstracts

Rationale: To reavel the therapeutic outcomes in intractable Lennox-Gastaut syndrome (LGS) after application of advanced medical and surgical treatment modalitiesMethods: Sixty-one intractable LGS patients refractory to 2 or more adequately chosen anti-epileptic drugs (AEDs) were reviewed to evaluate the anti-epileptic efficacy on various modes of medical and surgical treatments including further AED trial, steroid, ketogenic diet (KD), corpus callosotomy, respective surgery and VNS applicationResults: All patients had single (atonic, generalized tonic, atypical absence, myoclonic, generalized tonic-clonic) or mixed types (n=21, 34.4%) of generalized seizures. Three patients were accompanied by complex partial seizures. Cryptogenic group was 24 (39.3%). In symptomatic group (n=37), variable etiologies were included such as malformation of cortical development (n=17), destructive (n=15), metabolic (n=3), chromosomal anomaly (n=1) and tuberous sclerosis (n=1), respectively. Patients were treated by multiple modalities [further AED trial, steroid 5, ketogenic diet 37, surgery 31 (VNS 9, corpus callosotomy 14, resective surgery 16)]. In 61 cases of further AED trials, 8 (13.1%) patiens became seizure free, and 23 (37.7%) cases showed seizure reduction over 50%. In 37 cases on KD, 14 (42.4%) cases became seizure free, and 6 (18.2%) cases showed seizure reduction over 50%. In 14 cases of corpus callosotomy, 3 cases (21.4%) became seizure free. In 16 cases of resective surgery, 12 (75%) cases became seizure free. In 9 cases of VNS, 2 cases showed more than 50% of seizure reduction. In 5 cases of steroids, 2 cases became seizure free. In intractable LGS, overall seizure free outcome was 35 (57.4%) and seizure reduction over 50% was 53 (86.9%).Conclusions: By the applications of advanced modalities of medical and surgical treatment actively, 57.4% of intractable LGS could achieve the seizure free outcome.