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Journal of the Korean Child Neurology Society 2007;15(2):154-161.
Published online November 30, 2007.
Multimodal Management of Lennox-Gastaut Syndrome.
Mi Sun Yum, Seok Ho Hong, Jung Kyo Lee, Su Jeong You, Deok Soo Kim, Tae Sung Ko
1Department of Pediatric, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. tsko@amc.seoul.kr
2Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
3Department of Pediatrics and Epilepsy Center, Sang-gye Paik Hospital College of Medicine, Inje University, Seoul, Korea.
4Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea.
Abstract
PURPOSE
Lennox-Gastaut syndrome(LGS) is a childhood epileptic encephalopathy characterized by an electroclinical triad of generalized slow spike and wave activities in the EEG, multiple types of epileptic seizures, and slow mental development. We have attempted to evaluate the efficacy of diverse treatment modalities including epilepsy surgery, ketogenic diet and vagus nerve stimulation as well as new antiepileptic drugs(AEDs) in patients with LGS. METHODS: We retrospectively reviewed the medical records of 79 patients who were managed as Lennox-Gastaut syndrome at Asan Medical Center from April 1993 to March 2006. Their clinical characteristics, EEG, brain MRI findings, and applied treatment modalities were analyzed. Pre- and post-treatment seizure counts were obtained from monthly diary annotations by their families or caregivers. RESULTS: Among these 79 patients, 51 were males. The mean age of their first seizure was 1.9 years and the mean age of their first clinic visit was 4.6 years. Seizure freedom longer than one year was noted in 23 of the 79 patients(29.1%; AED in only 10 of 78 patients, three of 22 patients on a ketogenic diet, seven of 28 patients callosotomy, one patient hemispherectomy, and 2 patients cortical lesionectomy). Measurable improvement (>50%) was noted in 67 of the 79 patients(84.8%) by multimodal treatments. CONCLUSION: Lennox-Gastaut syndrome is recognized as intractable epilepsy. However, patient-designed multi-modality treatment can usually be very helpful for most of these patients.
Key Words: Lennox-Gastaut syndrome, Children, Epilepsy, Intractable, Treatment


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