Corpus Callosotomy for Medically Intractable Seizures

Abstract

To identify factors influencing outcome and morbidity in patients selected for corpus callosotomy, we retrospectively reviewed 23 patients with intractable generalized seizures who underwent corpus callosotomy between 1991 and 1994. Three patients had a complete corpus callosotomy, while 20 had an anterior callosotomy. Three of those patients subsequently had completion of the anterior callosotomy. Overall, 41% of patients were nearly or completely free of the seizure types targeted for surgical treatment, while another 45 % had seizures less than half as frequently. Four patients developed simple partial motor seizures after callosotomy. A transient disconnection syndrome was observed in 57% of patients. The best predictor of good outcome was a normal preoperative MRI. Mentally retarded patients had poorer outcomes. Outcome was not predicted by extent of callosal section or lateralization on neurological examination, EEG, MRI, and SPECT. Completion of anterior callosotomy resulted in significant reductions in seizure frequency. Though most patients do not become seizure-free after corpus callosotomy, worthwhile palliation of an otherwise intractable illness can be achieved. An analysis of prognostic factors should lead to better selection of patients for surgery.

Callosotomy for Epilepsy After West Syndrome

“…In contrast, Spencer et al (40) observed that two seizure types, low verbal IQ and diffuse ictal EEG patterns, were more frequent in anterior callosotomy failures, and that total callosotomy was warranted for tonic and tonic-clonic seizures with diffuse EEG paroxysms. Sorensen et al (41) also found that normal MRI predicted good outcome, but they noticed that neither neurologic examination nor EEG had any prognostic value.…”

Corpus Callosotomy with the CO₂ Laser Suction Device: A Technical Note

“…Permanent neurological deficits due to trauma, infarction, or intracerebral hemorrhage occur in less than 4% of patients [13] . Disconnection syndrome in children aged 12 years and younger was reported in 45% of cases, while 67% of older patients were affected and remained symptomatic longer [14] . Approximately 50-66% of patients experience a 50% reduction in the frequency of seizures, with few becoming seizure free [9,10] .…”

Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox–Gastaut syndrome

“…In addition, callosotomy frequently caused a reduction in seizure frequency and severity rather than the transformation of a generalized seizure to a lateralized or partial one. [10][11][12][13][14] Spencer et al found that new or more intense partial seizures occasionally occurred after callosotomy. They hypothesized that the residual partial seizures could actually be fragments of previous generalized seizures.…”