Efficacy and safety of corpus callosotomy versus vagus nerve stimulation as long-term adjunctive therapies in children with Lennox-Gastaut syndrome: Experience of a tertiary care center.

OBJECTIVES: To compare the efficacy and safety of corpus callosotomy versus vagus nerve stimulation (VNS) as long-term adjunctive therapies in children with Lennox-Gastaut syndrome. METHODS: This retrospective study was conducted in King Fahad Medical City between 2010 and 2019. The authors identified and followed 9 patients with Lennox-Gastaut syndrome (LGS) who underwent corpus callosotomy or VNS implantation for at least 12 months; seizure frequency and major complications were monitored. Five patients with a mean age of 10.8±1.3 years had corpus callosotomy, and 4 patients with a mean age of 13.8±3.9 years were implanted with VNS stimulators. RESULTS: Reduction in seizure frequency was achieved in all 5 patients who underwent corpus callosotomy, with greater than 75% seizure reduction in more than 50% in one, and greater than 25% in 2 respectively. However, in those implanted with VNS, 2 (50%) patients achieved a reduction in seizure frequency of greater than 75% and 2 (50%) greater than 25%, respectively. No significant difference was observed between the 2 treatment groups. One patient who underwent corpus callosotomy suffered cerebrospinal fluid leakage, and swallowing difficulties in one patient who underwent VNS. CONCLUSION: Both corpus callosotomy and VNS are safe and effective as adjunctive treatments for LGS patients.

Infants routine video electroencephalogram findings in a Saudi tertiary hospital.

OBJECTIVE: To report the existence and describe the non-epileptic abnormalities, interictal epileptiform discharges, and seizures in routine electroencephalograms (EEGs) of infants in a tertiary hospital out-patient neurophysiology clinics. METHODS: This is a non-interventional, retrospective descriptive study that involved the review of 172 infants` EEGs conducted from July 2018 to June 2019 in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. RESULTS: Total of 172 EEGs were reviewed; 152 routine EEGs for infants and 20 neonatal EEGs. Seventy-six (50%) EEGs were reported to be normal. Among the remaining EEGs, 54 were characterized by generalized slow background abnormalities (31.3 %), seven (4%) by background asymmetry, one (0.5%) by generalized low amplitude, and one (0.5 %) by an alternate trace that was dysmature for age. Interictal epileptiform discharges (IED) were present in 75 (43.6%) EEGs and they were focal in 72 (41.8%) EEGs, and generalized spike wave discharges were seen in only 3 (1.7%) EEGs with focal interictal epileptiform discharges. A diagnosis of hypsarrythmia was made from 15 (8.7%) EEGs. There were seizures in 11 (6.4%) EEGs, of which three were in neonates (15% of neonatal EEGs), and 8 in infants (4.6 % of infant EEGs). CONCLUSION: Fifty % of routine infants` EEGs had abnormalities and hypsarrythmia was the most common abnormal background associated with seizures. Ictal discharges in form of generalized electrodecremental pattern associated clinically with epileptic spasm was the most common type of seizures.