Managing Complications Associated With Neuromodulation in Lennox-Gastaut Syndrome: Depobam Samanta, MD, MS, FAAP, FAES

WATCH TIME: 3 minutes

"Proactively discussing potential complications with patients and families is essential to ensure informed decision-making and better outcomes for neuromodulation therapy."

In the treatment paradigm for Lennox-Gastaut syndrome (LGS), there are a number of invasive neuromodulatory options, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). VS has been in use the longest, receiving FDA approval in 1997 for focal, drug-resistant epilepsy and extended approval in 2017 for children over 4 years old. DBS and RNS received more recent approvals for focal DRE, with DBS approved by the FDA in 2018 and RNS in 2013.

Although VNS is widely used to treat LGS and has been extensively evaluated through systematic reviews and meta-analyses, no randomized controlled trial has specifically focused on LGS. Nonetheless, the American Academy of Neurology supports the use of VNS for LGS based on various studies. To improve the applicability of these methods, members of the Pediatric Epilepsy Research Consortium (PERC) recently published a practical guidance on neuromodulation strategies in LGS, giving thoughts on patient selection criteria, expected seizure and non-seizure outcomes, and device management.

Led by Depobam Samanta, MD, MS, FAAP, FAES, the research also highlights potential complications of these approaches, and ways clinicians can work around them. Samanta, medical director of the Arkansas Children’s Comprehensive Epilepsy Program, recently sat down with NeurologyLive® to discuss these complications, such as throat irritation, coughing or voice changes. He also spoke on more serious complications, like hemorrhage, device failure, and infection, as well as the importance of proactive communication with patients and families about potential complications and tailoring neuromodulation settings to balance efficacy and minimize adverse events.

REFERENCE
1. Samanta D, Aungaroon G, Fine AL, et al. Neuromodulation Strategies in Lennox‐Gastaut Syndrome: Practical Clinical Guidance from the Pediatric Epilepsy Research Consortium. Epilepsy Research. 2025;210:107499. doi:10.1016/j.eplepsyres.2024.107499