Abstract
Background
Lennox-Gastaut syndrome (LGS) is a severe drug-resistant epileptic syndrome. Palliative
treatments such as corpus callosotomy (CC) and vagus nerve stimulation (VNS) have
emerged as treatments to reduce the number of seizures in patients. The aim of this
study is to compare the effectiveness of CC and VNS in patients with LGS studied in
the last 30 years.
Materials and Methods
We conducted a systematic review with meta-analysis and collected papers from PubMed
(MEDLINE), Ovidsp, Web of Science, and Cochrane Library data bases. The articles analyzed
were published between January 1990 and December 2020. Keywords were chosen based
on internal and external validation in the PubMed data base (the analysis is available
in the Supplementary Data Supplementary Appendix). Prospective or retrospective case
reports (n ≥ 2), case series, cohort studies, or case-control studies involving patients with
LGS were included in the analysis. We selected studies that had no age or sex restriction
and that provided data on seizures before and after treatments. Studies not written
in English, published without peer review, or not indexed in the data bases were excluded.
Other exclusion criteria were the absence of seizure data and the impossibility of
extracting this information from the studies. To analyze the results, we used the
random-effects model based on the assessment of heterogeneity (I2 statistics) in two scenarios. In scenario 1, we assessed the incidence of patients
with a seizure reduction ≥ 50%; in scenario 2, we assessed the incidence of patients
with a seizure reduction > 0%.
Results
Of the 7418 articles found using the keywords, 32 were considered eligible. Of these,
18 articles were on VNS (175 patients) and 14 on CC (107 patients). For scenario 1
(seizure reduction ≥ 50%), CC had an incidence of 65% (95% CI, 37%–94%), with an I2 value of 82.7%; VNS had an incidence of 34% (95% CI, 11%–57%), with an I2 value of 80.7%. For scenario 2 (seizure reduction > 0%), CC had an incidence of 80%
(95% CI, 58%–100%), with an I2 value of 84.7%; VNS had an incidence of 64% (95% CI, 38%–89%), with an I2 value of 90.8%. There was an overlap of confidence intervals, with no statistical
difference between the treatments in both scenarios.
Discussion
Our analysis of LGS showed that the CC and VNS treatments are significantly beneficial
to reducing seizures, without superiority between them.
Keywords
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Comment
Article info
Publication history
Published online: August 18, 2022
Accepted:
June 29,
2022
Received in revised form:
June 9,
2022
Received:
March 23,
2022
Footnotes
Source(s) of financial support: The authors reported no funding sources.
Conflict of Interest: The authors reported no conflict of interest.
Identification
Copyright
© 2022 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
