Comparing the effects of cortical resection and vagus nerve stimulation in patients with nonlesional extratemporal epilepsy

- First study comparing resection and VNS in nonlesional extratemporal epilepsy
- Both procedures had significant effect on seizures and did not differ significantly.
- McHugh classification did not show significant differences between procedures.
- We revealed a significantly higher number of Engel I + II patients in resections.
- Both procedures lead to significant decrease in admission costs.

The main purpose of this retrospective study was to compare the effects of resective surgery (RESgr-26 patients) and vagus nerve stimulation (VNSgr-35 patients) on seizure frequency (2 and 5 years after surgery) in patients with nonlesional extratemporal epilepsy (NLexTLE). We analyzed hospital admission costs directly associated with epilepsy (HACE) in both groups at the same follow-up. The decrease in seizure frequency from the preoperative levels, in both VNSgr and RESgr, was statistically significant (p < 0.001). The seizure frequency reduction did not differ significantly between the follow-up visits for either group (p = 0.221 at 2 years and 0.218 at 5 years). A significantly higher number of Engel I and Engel I + II patients were found in RESgr than in VNSgr at both follow-up visits (p = 0.04 and 0.007, respectively). Using McHugh classification, we did not find statistically significant differences between both groups at both follow-up visits. Hospital admission costs directly associated with epilepsy/patient/year in both RESgr and VNSgr dropped significantly at 2- and 5-year follow-up visit and this reduction was not statistically different between RESgr and VNSgr (p = 0.232).Both VNS and resective surgery cause comparably significant seizure reduction in NLexTLE. Resective surgery leads to a greater number of patients with excellent postoperative outcome (Engel I + II). The HACE reduction is statistically comparable between both groups.