Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: A systematic review

Rolston, John D.; Englot, Dario J.; Wang, Doris D.; Garcia, Paul A.; Chang, Edward F.

doi:10.1016/j.yebeh.2015.06.001

Cited by 73 publications

(57 citation statements)

References 40 publications

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“…Callosotomy utilization has decreased since the introduction of VNS, which also helps prevent tonic and atonic seizures, though there is disagreement regarding which intervention has the best efficacy/risk profile for this purpose [139,26,1,108,138]. One recent systematic review suggests that callosotomy may be more effective than VNS in reducing atonic seizure frequency [105]. It has also been proposed that both therapies may be employed together in certain patients with particularly debilitating drop attacks [64].…”

Section: Disconnection Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection.

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Section: Disconnection Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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“…There are a number of systematic reviews of surgical treatment for refractory epilepsy, but to date only one has focused on corpus callosotomy and one has compared corpus callosotomy to vagus nerve stimulation (VNS) . Hader et al .…”

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confidence: 99%

“…Generally, complete corpus callosotomy resulted in a greater reduction than partial corpus callosotomy but was associated with an increased risk of permanent disconnection syndrome compared with partial corpus callosotomy. Rolston et al . found that VNS is a reversible alternative to corpus callosotomy with fewer complications, but is less likely to have a clinically significant reduction in drop attacks.…”

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confidence: 99%

Corpus callosotomy outcomes in pediatric patients: A systematic review

2016

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SUMMARYObjective: Corpus callosotomy is a palliative neurosurgical treatment for patients with either generalized or multifocal refractory epilepsy and injurious drop attacks. This report aims to systematically review the pediatric literature. Methods: Medline, Embase, Web of Knowledge, and Scopus were searched systematically for published articles on treatment outcomes of corpus callosotomy for refractory epilepsy. Studies were included if the patient population was younger than 18 at the time of surgery and median follow-up was >1 year. Studies were excluded if resective surgery was also performed. Results: A total of 12 articles met inclusion criteria. All articles were retrospective case series, with the exception of one being a prospectively designed retrospective case series. There was very little agreement among authors on the definition of a good seizure outcome. Articles that used the Engel classification found that 88.2% of total corpus callosotomy patients had a worthwhile reduction in seizures compared with 58.6% of patients who underwent anterior corpus callosotomy (p < 0.05). Drop attacks improved from corpus callosotomy more than other generalized seizure types. Reported complications were minor in all but one patient, and one death was reported. Transient disconnection syndrome was significantly more likely in total corpus callosotomy than in anterior corpus callosotomy (12.5% vs. 0%; p < 0.05). Improvements in quality of life, behavior, and intelligence/development quotient, as well as parental satisfaction, were generally correlated with seizure outcome. There was no postcallosotomy change in the number of antiepileptic drugs. Significance: Total corpus callosotomy was significantly more likely to result in a reduction in seizures. Anterior corpus callosotomy was unlikely to result in disconnection syndrome. Although all of the papers drew a similar conclusion, the quality of evidence was low. At best, the evidence raises the hypothesis that corpus callosotomy is a safe and effective treatment for refractory generalized epilepsy. It is clear that a casecontrol or randomized trial is warranted.

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“…9 Compared to other treatment modality, a metaanalysis showed that callosotomy had better rate of seizure freedom and control than vagal nerve stimulation (VNS) for drop attacks. 10 Since earlier age at surgery resulted in better outcomes and lower complications, corpus callosotomy should be performed immediately once the epileptic patient is diagnosed as medically intractable. 11 The average duration from onset to surgery was 8.78±6.69 years, almost comparable with a study from the US (mean 8.4 years).…”

Section: Discussionmentioning

confidence: 99%

<p>Seizure Outcomes in Patients with Complete versus Anterior Corpus Callosotomy: Analysis of Outcome</p>

Arifin¹,

Muttaqin²,

Bakhtiar³

et al. 2020

IJGM

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Introduction: Corpus callosotomy (CCT) is a palliative procedure to treat injurious drop attacks or multifocal/generalized seizures in which resection of the epileptogenic focus is not feasible. We are presenting our experience in treating intractable epilepsy patients by CCT procedures. Methods: We observed 16 patients who underwent callosotomy (male to female ratio 7:9; adult to pediatric ratio 3:13). Initial seizure frequency was reported ranged from 1 to 2 attacks daily to very often (more than 20 episodes daily). Results: Our observation showed that among patients with drop attacks, complete and >90% seizure freedom was reported by 4 and 6 of 13 patients, respectively (76.9% combined). Conclusion: Our observation showed that corpus callosotomy yielded good outcome in patients with intractable epilepsy in Indonesia. Our observation showed total callosotomy achieved complete seizure freedom better compared to partial callosotomy patients.

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Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: A systematic review

Cited by 73 publications

References 40 publications

Seizure outcomes in nonresective epilepsy surgery: an update

Seizure outcomes in nonresective epilepsy surgery: an update

Corpus callosotomy outcomes in pediatric patients: A systematic review

<p>Seizure Outcomes in Patients with Complete versus Anterior Corpus Callosotomy: Analysis of Outcome</p>

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