Abstracts

Rationale: Patients with pharmacoresistant symptomatic/cryptogenic epilepsy without radiographic lesions and/or not candidates for surgical resection may benefit from palliative procedures, most commonly VNS placement or corpus callosotomy. Both procedures have relatively good efficacy when compared to additional trials of antiepileptic agents. VNS have been used for both partial and generalized seizure types and corpus callosotomy is most effective in reducing atonic or tonic seizures. If one procedure fails, the other remains a suitable option for decreasing specific seizure types. It is likely that simultaneously performing both procedures in suitable candidates may acutely prevent injuries, and may hasten or improve long-term control of atonic, partial and generalized seizures. It is unclear whether simultaneous performance of VNS and callosotomy would impact morbidity, or ultimate seizure control.Methods: We reviewed our database for patient who had a VNS, Corpus callosotomy or a combination of both procedures from January 2010 to present. Duration of hospital stay, acute and subacute morbidity and acute and prolonged seizures outcome was analyzed. Results: 78 children had epilepsy surgical procedures at our institution (Jan2010 present). 39 children had phase 2/3 evaluations and surgical resection, 3 of whom had CC s as a part of their procedure. Palliative procedures only were done in 39 children. 26 had VNS placement only, 8 had a partial (1) or complete (7) corpus callosotomy only and 5 had complete corpus callostomy/VNS combination. All patients who underwent the combined procedure were ambulatory and had frequent falls from atonic or tonic events prior to surgery. Children with lower neurocognitive abilities had complete CC s. Mean hospital stay was 6.1 days after corpus callosotomy alone, less than 23 hours after VNS alone, 6.6 days after the combined procedure. After callosotomy, three of 8 with CC alone had components of a disconnection syndrome that recovered rapidly in 2, but 1 patient required inpatient rehabilitation. None of the 5 with combined procedures had disconnection syndrome. All 5 patients with combination procedures are free of atonic and disabling seizures and 2 are seizure free. Conclusions: Corpus Callosotomy/VNS is a safe and worthwhile procedure in a subset of patients with intractable epilepsy. More studies are required to better define who would most benefit. It is only done in our institution in individuals with atonic/tonic, potentially injurious seizures along with other partial or generalized seizure types. The combined procedure did not significantly prolong hospital stay or worsen sub-acute morbidity. Although longer term follow up is required, seizure frequency was significantly reduced in all children with the combination procedure.