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Callosotomy vs Vagus Nerve Stimulation in the Treatment of Lennox-Gastaut Syndrome: A Systematic Review With Meta-Analysis

  • Davi Ferreira Soares
    Correspondence
    Address correspondence to: Davi Ferreira Soares, MSc, Department of Neurosurgery IAMSPE–State Government Employee Medical Assistance Institute, São Paulo, Brazil / Department of Neurosurgery FMABC- ABC Medical School, Santo André, Brazil.
    Affiliations
    Department of Neurosurgery IAMSPE–State Government Employee Medical Assistance Institute, São Paulo, Brazil

    Department of Neurosurgery, FMABC - ABC Medical School, Santo André, Brazil
    Search for articles by this author
  • Paulo Henrique Pires de Aguiar
    Affiliations
    Department of Neurosurgery IAMSPE–State Government Employee Medical Assistance Institute, São Paulo, Brazil

    Department of Neurosurgery, FMABC - ABC Medical School, Santo André, Brazil
    Search for articles by this author

      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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      References

        • Mastrangelo M.
        Lennox-Gastaut syndrome: a state of the art review.
        Neuropediatrics. 2017; 48: 143-151https://doi.org/10.1055/s-0037-1601324
        • Cross J.H.
        • Auvin S.
        • Falip M.
        • Striano P.
        • Arzimanoglou A.
        Expert opinion on the management of Lennox-Gastaut syndrome: treatment algorithms and practical considerations.
        Front Neurol. 2017; 8: 505https://doi.org/10.3389/fneur.2017.00505
        • Asadi-Pooya A.A.
        Lennox-Gastaut syndrome: a comprehensive review.
        Neurol Sci. 2018; 39: 403-414https://doi.org/10.1007/s10072-017-3188-y
        • Arzimanoglou A.
        • French J.
        • Blume W.T.
        • et al.
        Lennox-Gastaut syndrome: a consensus approach on diagnosis, assessment, management, and trial methodology.
        Lancet Neurol. 2009; 8: 82-93https://doi.org/10.1007/s10072-017-3188-y
        • Hancock E.C.
        • Cross J.H.
        Treatment of Lennox-Gastaut syndrome.
        Cochrane Database Syst Rev. 2013; 2013: CD003277https://doi.org/10.1002/14651858.CD003277
        • Morris 3rd, G.L.
        • Gloss D.
        • Buchhalter J.
        • Mack K.J.
        • Nickels K.
        • Harden C.
        Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the guideline development subcommittee of the American Academy of Neurology.
        Neurology. 2013; 81: 1453-1459https://doi.org/10.1212/WNL.0b013e3182a393d1
        • Lancman G.
        • Virk M.
        • Shao H.
        • et al.
        Vagus nerve stimulation vs. corpus callosotomy in the treatment of Lennox-Gastaut syndrome: a meta-analysis.
        Seizure. 2013; 22: 3-8https://doi.org/10.1016/j.seizure.2012.09.014
        • Cumming G.
        • Finch S.
        Inference by eye: confidence intervals and how to read pictures of data.
        Am Psychol. 2005; 60: 170-180https://doi.org/10.1037/0003-066X.60.2.170
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        J Clin Epidemiol. 2021; 134: 178-189https://doi.org/10.1186/s13643-021-01626-4
        • Higgins J.P.T.
        • Thomas J.
        • Chandler J.
        • et al.
        Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Handbook for Systematic Reviews of Interventions.
        John Wiley and Sons, 2019
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomised studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384https://doi.org/10.1136/jech.52.6.377
        • Hooper P.
        • Jutai J.W.
        • Strong G.
        • Russell-Minda E.
        Age-related macular degeneration and low-vision rehabilitation: a systematic review.
        Can J Ophthalmol. 2008; 43: 180-187https://doi.org/10.3129/i08-001
        • Higgins J.P.T.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558https://doi.org/10.1002/sim.1186
        • Kulinskaya E.
        • Stephan Morgenthaler R.G.S.
        Meta Analysis: A Guide to Calibrating and Combining Statistical Evidence. Vol 1. Wiley, 2008
        • Rodgers W.P.
        • Durnford A.J.
        • Kirkham F.J.
        • Whitney A.
        • Mullee M.A.
        • Gray W.P.
        Interrater reliability of Engel, International League Against Epilepsy, and McHugh seizure outcome classifications following vagus nerve stimulator implantation.
        J Neurosurg Pediatr. 2012; 10: 226-229https://doi.org/10.3171/2012.6.PEDS11424
        • Abdelmoity S.A.
        • Abdelmoity A.A.
        • Riordan S.M.
        • Kaufman C.
        • le Pichon J.B.
        • Abdelmoity A.
        The efficacy and tolerability of auto-stimulation-VNS in children with Lennox-Gastaut syndrome.
        Seizure. 2021; 86: 168-174https://doi.org/10.1016/j.seizure.2021.02.015
        • Cukiert A.
        • Cukiert C.M.
        • Mariani P.P.
        • Burattini J.A.
        Impact of cardiac-based vagus nerve stimulation closed-loop stimulation on the seizure outcome of patients with generalized epilepsy: a prospective, individual-control study.
        Neuromodulation. 2021; 24: 1018-1023https://doi.org/10.1111/ner.13290
        • Grasl S.
        • Janik S.
        • Dressler A.
        • et al.
        Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal/neuropediatric cooperation.
        Eur Arch Otorhinolaryngol. 2021; 278: 3891-3899https://doi.org/10.1007/s00405-021-06943-x
        • Winston G.M.
        • Guadix S.
        • Lavieri M.T.
        • et al.
        Closed-loop vagal nerve stimulation for intractable epilepsy: a single-center experience.
        Seizure. 2021; 88: 95-101https://doi.org/10.1016/j.seizure.2021.03.030
        • Honda R.
        • Baba H.
        • Adachi K.
        • et al.
        Developmental outcome after corpus callosotomy for infants and young children with drug-resistant epilepsy.
        Epilepsy Behav. 2021; 117107799https://doi.org/10.1016/j.yebeh.2021.107799
        • Ben-Menachem E.
        • Hellström K.
        • Waldton C.
        • Augustinsson L.E.
        Evaluation of refractory epilepsy treated with vagus nerve stimulation for up to 5 years.
        Neurology. 1999; 52: 1265-1267https://doi.org/10.1212/wnl.52.6.1265
        • Frost M.
        • Gates J.
        • Helmers S.L.
        • et al.
        Vagus nerve stimulation in children with refractory seizures associated with Lennox-Gastaut syndrome.
        Epilepsia. 2001; 42: 1148-1152https://doi.org/10.1046/j.1528-1157.2001.23900.x
        • Benifla M.
        • Rutka J.T.
        • Logan W.
        • Donner E.J.
        Vagal nerve stimulation for refractory epilepsy in children: indications and experience at the hospital for sick children.
        Childs Nerv Syst. 2006; 22: 1018-1026https://doi.org/10.1007/s00381-006-0123-6
        • Lundgren J.
        • Åmark P.
        • Blennow G.
        • Strömblad L.G.
        • Wallstedt L.
        Vagus nerve stimulation in 16 children with refractory epilepsy.
        Epilepsia. 1998; 39: 809-813https://doi.org/10.1111/j.1528-1157.1998.tb01173.x
        • Aldenkamp A.P.
        • Majoie H.J.M.
        • Berfelo M.W.
        • et al.
        Long-term effects of 24-month treatment with vagus nerve stimulation on behaviour in children with Lennox-Gastaut syndrome.
        Epilepsy Behav. 2002; 3: 475-479https://doi.org/10.1016/s1525-5050(02)00517-6
        • Parker A.P.
        • Polkey C.E.
        • Binnie C.D.
        • Madigan C.
        • Ferrie C.D.
        • Robinson R.O.
        Vagal nerve stimulation in epileptic encephalopathies.
        Pediatrics. 1999; 103: 778-782https://doi.org/10.1542/peds.103.4.778
        • Rolston J.D.
        • Englot D.J.
        • Wang D.D.
        • Garcia P.A.
        • Chang E.F.
        Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: a systematic review.
        Epilepsy Behav. 2015; 51: 13-17https://doi.org/10.1016/j.yebeh.2015.06.001
        • Kyriacou D.N.
        The enduring evolution of the P value.
        JAMA. 2016; 315: 1113-1115https://doi.org/10.1001/jama.2016.2152
        • James G.
        • Wittern D.
        • Trevor Hastie R.T.
        An Introduction to Statistical Learning with Applications in R.
        (Springer Texts in Statistics). Spinger, 2013
        • Samprit Chatterjee
        • Hadi A.S.
        4th ed. Regression Analysis by Example. Vol. 4. Wiley Series in Probability and Statistics, 2006
        • Elger C.E.
        • Hoppe C.
        Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection.
        Lancet Neurol. 2018; 17: 279-288https://doi.org/10.1016/S1474-4422(18)30038-3
        • Papini M.
        • Pasquinelli A.
        • Armellini M.
        • Orlandi D.
        Alertness and incidence of seizures in patients with Lennox-Gastaut syndrome.
        Epilepsia. 1984; 25: 161-167https://doi.org/10.1111/j.1528-1157.1984.tb04172.x
        • Hoppe C.
        • Poepel A.
        • Elger C.E.
        Epilepsy: accuracy of patient seizure counts.
        Arch Neurol. 2007; 64: 1595-1599https://doi.org/10.1001/archneur.64.11.1595
        • Asadi-Pooya A.A.
        • Malekmohamadi Z.
        • Kamgarpour A.
        • et al.
        Corpus callosotomy is a valuable therapeutic option for patients with Lennox-Gastaut syndrome and medically refractory seizures.
        Epilepsy Behav. 2013; 29: 285-288https://doi.org/10.1016/j.yebeh.2013.08.011
        • Tanriverdi T.
        • Olivier A.
        • Poulin N.
        • Andermann F.
        • Dubeau F.
        Long-term seizure outcome after corpus callosotomy: a retrospective analysis of 95 patients.
        J Neurosurg. 2009; 110: 332-342https://doi.org/10.3171/2008.3.17570
        • de Rinaldis M.
        • Gigante N.
        • Trabacca A.
        Unusual early positive outcome of VNS therapy: anecdotal honeymoon or atypical prolonged immediate changes?.
        Acta Neurol Belg. 2017; 117: 793-794https://doi.org/10.1007/s13760-017-0767-x
        • Révész D.
        • Rydenhag B.
        • Ben-Menachem E.
        Complications and safety of vagus nerve stimulation: 25 years of experience at a single center.
        J Neurosurg Pediatr. 2016; 18: 97-104https://doi.org/10.3171/2016.1.PEDS15534
        • Cukiert A.
        • Cukiert C.M.
        • Burattini J.A.
        • et al.
        A prospective long-term study on the outcome after vagus nerve stimulation at maximally tolerated current intensity in a cohort of children with refractory secondary generalized epilepsy.
        Neuromodulation. 2013; 16: 551-556https://doi.org/10.1111/j.1525-1403.2012.00522.x
        • Chan A.Y.
        • Rolston J.D.
        • Lee B.
        • Vadera S.
        • Englot D.J.
        Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: a meta-analysis.
        J Neurol Surg. 2019; 130: 1193-1202https://doi.org/10.3171/2017.12.JNS172331
        • Mithani K.
        • Mikhail M.
        • Morgan B.R.
        • et al.
        Connectomic profiling identifies responders to vagus nerve stimulation.
        Ann Neurol. 2019; 86: 743-753https://doi.org/10.1002/ana.25574
        • Zhu J.
        • Xu C.
        • Zhang X.
        • et al.
        The changes in the topological properties of brain structural network based on diffusion tensor imaging in pediatric epilepsy patients with vagus nerve stimulators: a graph theoretical analysis.
        Brain Dev. 2021; 43: 97-105https://doi.org/10.1016/j.braindev.2020.07.006
        • Liang J.G.
        • Lee D.
        • Youn S.E.
        • Kim H.D.
        • Kim N.Y.
        Electroencephalography network effects of corpus callosotomy in patients with Lennox-Gastaut syndrome.
        Front Neurol. 2017; 8: 456https://doi.org/10.3389/fneur.2017.00456
        • Hong J.
        • Desai A.
        • Thadani V.M.
        • Roberts D.W.
        Efficacy and safety of corpus callosotomy after vagal nerve stimulation in patients with drug-resistant epilepsy.
        J Neurosurg. 2018; 128: 277-286https://doi.org/10.3171/2016.10.JNS161841
        • Labar D.
        • Nikolov B.
        • Tarver B.
        • Fraser R.
        Vagus nerve stimulation for symptomatic generalized epilepsy: a pilot study.
        Epilepsia. 1998; 39: 201-205https://doi.org/10.1111/j.1528-1157.1998.tb01359.x
        • Hosain S.
        • Nikalov B.
        • Harden C.
        • Li M.
        • Fraser R.
        • Labar D.
        Vagus nerve stimulation treatment for Lennox-Gastaut syndrome.
        J Child Neurol. 2000; 15: 509-512
        • Boon P.
        • Vonck K.
        • Van Walleghem P.
        • et al.
        Programmed and magnet-induced vagus nerve stimulation for refractory epilepsy.
        J Clin Neurophysiol. 2001; 18: 402-407https://doi.org/10.1097/00004691-200109000-00003
        • Nagarajan L.
        • Walsh P.
        • Gregory P.
        • Lee M.
        VNS therapy in clinical practice in children with refractory epilepsy.
        Acta Neurol Scand. 2002; 105: 13-17https://doi.org/10.1034/j.1600-0404.2002.00129.x
        • Nakken K.O.
        • Henriksen O.
        • Røste G.K.
        • Lossius R.
        Vagal nerve stimulation—the Norwegian experience.
        Seizure. 2003; 12: 37-41https://doi.org/10.1016/s1059131102001383
        • Buoni S.
        • Mariottini A.
        • Pieri S.
        • et al.
        Vagus nerve stimulation for drug-resistant epilepsy in children and young adults.
        Brain Dev. 2004; 26: 158-163https://doi.org/10.1016/S0387-7604(03)00120-7
        • Majoie H.J.M.
        • Berfelo M.W.
        • Aldenkamp A.P.
        • Renier W.O.
        • Kessels A.G.H.
        Vagus nerve stimulation in patients with catastrophic childhood epilepsy, a 2-year follow-up study.
        Seizure. 2005; 14: 10-18https://doi.org/10.1016/j.seizure.2004.02.003
        • Hallböök T.
        • Lundgren J.
        • Stjernqvist K.
        • Blennow G.
        • Strömblad L.G.
        • Rosén I.
        Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood.
        Seizure. 2005; 14: 504-513https://doi.org/10.1016/j.seizure.2005.08.007
        • Rychlicki F.
        • Zamponi N.
        • Trignani R.
        • Ricciuti R.A.
        • Iacoangeli M.
        • Scerrati M.
        Vagus nerve stimulation: clinical experience in drug-resistant pediatric epileptic patients.
        Seizure. 2006; 15: 483-490https://doi.org/10.1016/j.seizure.2006.06.001
        • Casazza M.
        • Avanzini G.
        • Ferroli P.
        • Villani F.
        • Broggi G.
        Vagal nerve stimulation: relationship between outcome and electroclinical seizure pattern.
        Seizure. 2006; 15: 198-207https://doi.org/10.1016/j.seizure.2006.02.003
        • Rossignol E.
        • Lortie A.
        • Thomas T.
        • et al.
        Vagus nerve stimulation in pediatric epileptic syndromes.
        Seizure. 2009; 18: 34-37https://doi.org/10.1016/j.seizure.2008.06.010
        • Shahwan A.
        • Bailey C.
        • Maxiner W.
        • Harvey A.S.
        Vagus nerve stimulation for refractory epilepsy in children: more to VNS than seizure frequency reduction.
        Epilepsia. 2009; 50: 1220-1228https://doi.org/10.1111/j.1528-1167.2008.01940.x
        • Qiabi M.
        • Bouthillier A.
        • Carmant L.
        • Nguyen D.K.
        Vagus nerve stimulation for epilepsy: the Notre-Dame hospital experience.
        Can J Neurol Sci. 2011; 38: 902-908https://doi.org/10.1017/s0317167100012506
        • Zamponi N.
        • Passamonti C.
        • Cesaroni E.
        • Trignani R.
        • Rychlicki F.
        Effectiveness of vagal nerve stimulation (VNS) in patients with drop-attacks and different epileptic syndromes.
        Seizure. 2011; 20: 468-474https://doi.org/10.1016/j.seizure.2011.02.011
        • Cersósimo R.O.
        • Bartuluchi M.
        • de Los Santos C.
        • Bonvehi I.
        • Pomata H.
        • Caraballo R.H.
        Vagus nerve stimulation: effectiveness and tolerability in patients with epileptic encephalopathies.
        Childs Nerv Syst. 2011; 27: 787-792https://doi.org/10.1007/s00381-010-1314-8
        • Narayanan J.
        An observational report of worsening seizures with increase in total charge delivered per day by vagus nerve stimulation in 4 patients with Lennox-Gastaut syndrome.
        Brain Stimul. 2016; 9: 310-311https://doi.org/10.1016/j.brs.2015.11.004
        • Sakaki T.
        • Nakase H.
        • Morimoto T.
        • Hoshida T.
        • Tsunoda S.
        Partial corpus callosotomy beneficial for Lennox-Gastaut syndrome--report of two cases.
        Neurol Med Chir (Tokyo). 1991; 31: 226-232https://doi.org/10.2176/nmc.31.226
        • Oguni H.
        • Olivier A.
        • Andermann F.
        • Comair J.
        Anterior callosotomy in the treatment of medically intractable epilepsies: a study of 43 patients with a mean follow-up of 39 months.
        Ann Neurol. 1991; 30: 357-364https://doi.org/10.1002/ana.410300307
        • Andersen B.
        • Rogvi-Hansen B.Á.
        • Kruse-Larsen C.
        • Dam M.
        Corpus callosotomy: seizure and psychosocial outcome. A 39-month follow-up of 20 patients.
        Epilepsy Res. 1996; 23: 77-85https://doi.org/10.1016/0920-1211(95)00052-6
        • Kwan S.Y.
        • Wong T.T.
        • Chang K.P.
        • et al.
        Seizure outcomes after anterior callosotomy in patients with posterior-dominant and with anterior-dominant epileptiform discharges.
        Childs Nerv Syst. 2001; 17: 71-75https://doi.org/10.1007/pl00013725
        • Turanli G.
        • Yalnızoğlu D.
        • Genç-Açıkgöz D.
        • Akalan N.
        • Topçu M.
        Outcome and long-term follow-up after corpus callosotomy in childhood onset intractable epilepsy.
        Childs Nerv Syst. 2006; 22: 1322-1327https://doi.org/10.1007/s00381-006-0045-3
        • Jea A.
        • Vachhrajani S.
        • Johnson K.K.
        • Rutka J.T.
        Corpus callosotomy in children with intractable epilepsy using frameless stereotactic neuronavigation: 12-year experience at the hospital for sick children in Toronto.
        Neurosurg Focus. 2008; 25: E7https://doi.org/10.3171/FOC/2008/25/9/E7
        • Jalilian L.
        • Limbrick D.D.
        • Steger-May K.
        • Johnston J.
        • Powers A.K.
        • Smyth M.D.
        Complete versus anterior two-thirds corpus callosotomy in children: analysis of outcome.
        J Neurosurg Pediatr. 2010; 6: 257-266https://doi.org/10.3171/2010.5.PEDS1029
        • Lin J.S.
        • Lew S.M.
        • Marcuccilli C.J.
        • et al.
        Corpus callosotomy in multistage epilepsy surgery in the pediatric population.
        J Neurosurg Pediatr. 2011; 7: 189-200https://doi.org/10.3171/2010.11.PEDS10334
        • Iwasaki M.
        • Uematsu M.
        • Hino-Fukuyo N.
        • et al.
        Clinical profiles for seizure remission and developmental gains after total corpus callosotomy.
        Brain Dev. 2016; 38: 47-53https://doi.org/10.1016/j.braindev.2015.04.010
        • Taraschenko O.
        • Pedavally S.
        • Samson K.K.
        • Puccioni M.J.
        • Madhavan D.
        Anterior corpus callosotomy in patients with drug-resistant epilepsy: invasive EEG findings and seizure outcomes.
        Epilepsy Behav Case Rep. 2018; 9: 12-18https://doi.org/10.1016/j.ebcr.2017.12.001
        • Liang J.G.
        • Kim N.Y.
        • Ko A.
        • Kim H.D.
        • Lee D.
        Changes in functional brain network topology after successful and unsuccessful corpus callosotomy for Lennox-Gastaut syndrome.
        Sci Rep. 2018; 8: 3414
        • Hung S.C.
        • Lee C.C.
        • Chen H.H.
        • et al.
        Early recovery of interhemispheric functional connectivity after corpus callosotomy.
        Epilepsia. 2019; 60: 1126-1136https://doi.org/10.1038/s41598-018-21764-5
        • Kanai S.
        • Okanishi T.
        • Nishimura M.
        • et al.
        Insufficient efficacy of corpus callosotomy for epileptic spasms with biphasic muscular contractions.
        Front Neurol. 2020; 11: 232https://doi.org/10.3389/fneur.2020.00232
        • Thohar Arifin M.T.
        • Muttaqin Z.
        • Bakhtiar Y.
        • et al.
        Seizure outcomes in patients with complete versus anterior corpus callosotomy: analysis of outcome.
        Int J Gen Med. 2020; 13: 105-110https://doi.org/10.2147/IJGM.S247438

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