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Patients with Lennox–Gastaut syndrome (persistent tonic, myoclonic, and astatic seizures) have a poor prognosis. Seizures occur daily in most individuals and persist in 60 to 80%.1 Callosotomy may reduce seizure frequency, particularly for those with astatic seizures, but complete control is rare.1 A preliminary report suggested that vagus nerve stimulation (VNS) might improve seizure control and quality of life,2 although to our knowledge no completely seizure-free outcome for patients with this syndrome has been reported following this approach.
Case report.
The patient was a 22-year-old white man referred to our clinic at age 18 years for drug-resistant epilepsy with astatic seizures. High-field (1.5 T) brain MRI showed an abnormal arrangement of the sulcal pattern in the frontal lobes and diffuse polymicrogyria in the frontal, temporal, insular, and parietal lobes (figure, A through C). Brain SPECT scanning showed hypoperfusion of the right fronto-parieto-occipital regions and the left parieto-occipital regions. The patient had severe mental retardation, an IQ of 47 (Raven …
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