title: Combination of corpus callosotomy and vagus nerve stimulation in the treatment of refractory epilepsy.
abstract: BACKGROUND
  Palliative techniques such as partial corpus callosotomy (CC) and vagus nerve stimulation (VNS) may be effective for adequate control of seizures in pharmacoresistant patients who are not candidates for resective surgery.
  
  
  OBJECTIVE
  The objective of this study was to analyze the efficacy of the combination of these two techniques in patients where the first surgery had not achieved adequate control.
  
  
  METHODS
  This is a retrospective review of 6 patients with refractory epilepsy in which both types of surgery were performed, CC and VNS. We analyzed variables such as age, sex, age at onset of epilepsy, seizure types, electroencephalogram and magnetic resonance imaging results, and number of pre- and postoperative seizures.
  
  
  RESULTS
  Three patients first underwent VNS and then CC, and 3 patients were treated in reverse order. All patients had some improvement after the first surgery, but they continued to experience persistent falls, so a second palliative technique was used. The mean improvement after both surgeries was 89% (90% in patients first receiving CC and 87% in patients who first underwent VNS).
  
  
  CONCLUSIONS
  In adequately studied patients who are not optimal candidates for resective surgery, palliative surgery is a choice. The combination of VNS and CC shows good results in our series, although the right order to perform both procedures has not been defined. These results should be confirmed in a larger group of patients.
authors: Servicio de Neurología y Neurocirugía, Unidad Multidisciplinar de Epilepsia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors: E
authors: E
authors: Guillamón
authors: J
authors: J
authors: Miró
authors: A
authors: A
authors: Gutiérrez
authors: R
authors: R
authors: Conde
authors: M
authors: M
authors: Falip
authors: S
authors: S
authors: Jaraba
authors: G
authors: G
authors: Plans
authors: M
authors: M
authors: Garcés
authors: V
authors: V
authors: Villanueva
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D003337:Corpus Callosum / Q000601:surgery*; D004569:Electroencephalography; D004827:Epilepsy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D012640:Seizures / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D012737:Sex Factors; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation; D055815:Young Adult