Elimination of medically intractable epileptic drop attacks following endoscopic total corpus callosotomy in Rett syndrome

2017 ◽  
Vol 33 (11) ◽  
pp. 1883-1887 ◽  
Author(s):  
Keisuke Ueda ◽  
Sandeep Sood ◽  
Eishi Asano ◽  
Ajay Kumar ◽  
Aimee F. Luat
Keyword(s):  
Rett Syndrome ◽  
Corpus Callosotomy ◽  
Drop Attacks

scholarly journals Surgical Aspects of Corpus Callosotomy

2021 ◽  
Vol 11 (12) ◽  
pp. 1608
Author(s):  
Takehiro Uda ◽  
Noritsugu Kunihiro ◽  
Ryoko Umaba ◽  
Saya Koh ◽  
Toshiyuki Kawashima ◽  
...  
Keyword(s):  
Recent Progress ◽  
Epileptic Activity ◽  
Contralateral Side ◽  
Review Article ◽  
Corpus Callosotomy ◽  
Drop Attacks ◽  
Maximum Effort ◽  
Surgical Aspects ◽  
Low Prevalence ◽  
The Brain

Corpus callosotomy (CC) is one of the options in epilepsy surgeries to palliate patient seizures, and is typically applied for drop attacks. The mechanisms of seizure palliation involve disrupting the propagation of epileptic activity to the contralateral side of the brain. This review article focuses on the surgical aspects of CC. As a variations of CC, anterior two-thirds, posterior one-third, and total callosotomy are described with intraoperative photographs. As less-invasive surgical variations, recent progress in endoscopic CC, and CC without craniotomy, is described. CC remains acceptable under the low prevalence of complications, and surgeons should make the maximum effort to minimize the complication rate.

Outcome after corpus callosotomy in children with injurious drop attacks and severe mental retardation

2007 ◽  
Vol 29 (9) ◽  
pp. 577-585 ◽  
Author(s):  
Chaturbhuj Rathore ◽  
Mathew Abraham ◽  
Ravi Mohan Rao ◽  
Annamma George ◽  
P. Sankara Sarma ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Severe Mental Retardation ◽  
Corpus Callosotomy ◽  
Drop Attacks

Seizure Outcomes After Corpus Callosotomy for Drop Attacks

Neurosurgery ◽  
2013 ◽  
Vol 73 (6) ◽  
pp. 993-1000 ◽  
Author(s):  
Regina S. Bower ◽  
Elaine Wirrell ◽  
Macaulay Nwojo ◽  
Nicholas M. Wetjen ◽  
W. Richard Marsh ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Seizure Onset ◽  
Corpus Callosotomy ◽  
Drop Attacks ◽  
Younger Age ◽  
Age At Surgery ◽  
Adults And Children

Abstract BACKGROUND: Medically intractable epilepsy involving drop attacks can be difficult to manage and negatively affect quality of life. Most studies investigating the effect of corpus callosotomy (CC) on seizures have been limited, focusing on the pediatric population or drop seizures alone, with little attention to other factors influencing seizure outcome. OBJECTIVE: To assess seizure outcomes after CC in adults and children. METHODS: Retrospective analysis was performed on all patients who underwent CC (anterior two thirds, 1- or 2-stage complete) at our institution between 1990 and 2011. Change in frequency after CC was assessed for drop seizures and other seizure types. Multiple factors were evaluated for impact on seizure outcome. RESULTS: Fifty patients met inclusion criteria. The median age was 1.5 years at seizure onset and 17 years at time of surgery. Anterior two-thirds CC was performed in 28 patients, 1-stage complete in 17, and 2-stage complete in 5. All 3 groups experienced a significant decrease in drop seizures (P < .001, P < .001, and P = .020, respectively), with 40% experiencing complete resolution, and 64% dropping at least 1 frequency category. Other seizure types significantly decreased in anterior two-thirds CC and 1-stage complete (P = .0035, P = .001, respectively). Younger age at surgery correlated with better seizure outcomes (P = .043). CONCLUSION: CC for medically refractory generalizing epilepsy is effective for both drop seizures and other seizure types. CC should be considered soon after a patient has been deemed medically refractory because earlier age at surgery results in lower risk and better outcome.

scholarly journals Neurology (Epilepsy and EEG)

2015 ◽  
Vol 42 (S1) ◽  
pp. S25-S26
Author(s):  
PL Roy ◽  
JF Tellez-Zenteno ◽  
A Wu
Keyword(s):  
Seizure Control ◽  
Delayed Response ◽  
Corpus Callosotomy ◽  
Drop Attacks ◽  
Potential Explanation ◽  
Clear Explanation ◽  
Different Types ◽  
Grand Mal ◽  
Antiepileptic Medications ◽  
Generalized Epilepsy

Background: Corpus callosotomy is a palliative surgical procedure involving partial or complete disconnection of the corpus callosum. It has been shown to improve outcomes of seizure control with in six months of the procedure. Here, we discuss a challenging case of intractable generalized epilepsy with a delayed response to corpus callosotomy. Methods: This report describes a 23 year old female with onset of seizures since age 16. Patient was followed over 7 year period for evolution of her seizures and treatment. Results: Patient experienced three different types of seizures including atypical absences, drop attacks and grand mal seizures. The most disabling type of seizures were the drop attacks associated with injuries. MRI showed bilateral subependymal heterotopia. Multiple EEG telemetry studies showed generalized spike waves without clear lateralization or focalization. Patient failed seven different antiepileptic medications, ketogenic diet and vagal nerve stimulation. Treatment with anterior corpus callosotomy started to show improvements at 18-24 months after the procedure with less severe drop attacks. Conclusions: Corpus callosotomy usually works few months after surgery. This is a very atypical case in whom callosotomy had a delayed response. This is rarely reported and we do not have a clear explanation. Delayed re-organization of the pathways associated with the seizure initiation may be a potential explanation.

Endoscopic-Assisted (Through a Mini Craniotomy) Corpus Callosotomy Combined With Anterior, Hippocampal, and Posterior Commissurotomy in Lennox-Gastaut Syndrome

Neurosurgery ◽  
2015 ◽  
Vol 78 (5) ◽  
pp. 743-751 ◽  
Author(s):  
Sarat P. Chandra ◽  
Nilesh S. Kurwale ◽  
Sarabjit Singh Chibber ◽  
Jyotirmoy Banerji ◽  
Rekha Dwivedi ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Seizure Frequency ◽  
Child Behavior Checklist ◽  
Seizure Type ◽  
Severe Mental Retardation ◽  
Corpus Callosotomy ◽  
Posterior Commissure ◽  
Drop Attacks ◽  
Palliative Procedure ◽  
Syndromic Diagnosis

Abstract BACKGROUND: Corpus callosotomy is a palliative procedure especially for Lennox-Gastaut semiology without localization with drop attacks. OBJECTIVE: To describe endoscopic-assisted complete corpus callosotomy combined with anterior, hippocampal, and posterior commissurotomy. METHODS: Patients with drug refractory epilepsy having drop attacks as the predominant seizure type, bilateral abnormalities on imaging, and moderate to severe mental retardation were included. All underwent a complete workup (including magnetic resonance imaging). RESULTS: Patients (n = 16, mean age 11.4 ± 6.4 years, range 6-19 years) had a mean seizure frequency of 24.5 ± 19.8/days (range 1-60) and a mean intelligence quotient of 25.23 ± 10.71. All had syndromic diagnosis of Lennox-Gastaut syndrome, with the following etiologies: hypoxic insult (10), lissencephaly (2), bilateral band heterotropia (2), and microgyria and pachygyria (2). Surgery included complete callosotomy and the section of anterior and posterior commissure by microscopic approach through a mini craniotomy (11) and endoscopic-assisted approach (5). Complications included meningitis (1), hyperammonemic encephalopathy (2), and acute transient disconnection (5). There was no mortality or long-term morbidity. Mean follow-up was 18 ± 4.7 months (range 16-27 months). Drop attacks stopped in all. Seizure frequency/duration decreased >90% in 10 patients and >50% in 5 patients, and increased in 1 patient. All patients attained presurgical functional levels in 3 to 6 months. Child behavior checklist scores showed no deterioration. Parental questionnaires reported 90% satisfaction attributed to the control of drop attacks. The series was compared retrospectively with an age/sex-matched cohort (where a callosotomy only was performed), and showed better outcome for drop attacks (P < .003). CONCLUSION: This preliminary study demonstrated the efficacy and safety of complete callosotomy with anterior, hippocampal, and posterior commissurotomy in Lennox-Gastaut syndrome (drop attacks) with moderate to severe mental retardation.

Commissurotomies in Children

1994 ◽  
Vol 9 (2_suppl) ◽  
pp. 2S50-2S60 ◽  
Author(s):  
Lionel Carmant ◽  
Gregory L. Holmes
Keyword(s):  
Epileptic Focus ◽  
Corpus Callosotomy ◽  
Drop Attacks ◽  
Seizure Disorders ◽  
Quality Of Life Measures ◽  
Generalized Seizures ◽  
Long Term Follow Up

Although corpus callosotomy has been used since 1940 to treat severe, medically intractable seizure disorders, controversy remains as to when, or even if, the surgery should be performed. Unlike other types of surgical therapy of epilepsy where the epileptic focus is identified and removed, corpus callosotomy is used to interrupt the propagation of epileptic discharges. The procedure is primarily used in patients with secondarily generalized seizures in whom focal resections are not possible. Long-term follow-up studies of post-callosotomy patients are few and flawed by lack of accurate seizure counts and quality-of-life measures. Although it remains difficult to predict those patients who will benefit from the surgery, it appears that patients with "drop" attacks benefit the most from the procedure. (J Child Neurol 1994;9(Suppl):2S50-2S60).

Extraventricular corpus callosotomy

2011 ◽  
Vol 114 (6) ◽  
pp. 1698-1700 ◽  
Author(s):  
Jacob R. Joseph ◽  
Ashwin Viswanathan ◽  
Daniel Yoshor
Keyword(s):  
Corpus Callosum ◽  
Mr Imaging ◽  
Septum Pellucidum ◽  
The Body ◽  
Corpus Callosotomy ◽  
Cavum Septum Pellucidum ◽  
Drop Attacks ◽  
Lateral Ventricles ◽  
Intractable Seizures ◽  
Anatomical Basis

Corpus callosotomy offers useful palliation for selected patients with medically intractable seizures, particularly those with uncontrolled and disabling drop attacks. Here the authors present their technique for performing a corpus callosotomy that allows for complete sectioning of the callosum while avoiding entry into the lateral ventricles. The anatomical basis for the technique is the presence of a definable cleft just ventral to the corpus callosum in the midline, formed by the fusion of the two laminae of the septum pellucidum. This small cleft is typically present even in the absence of a cavum septum pellucidum on MR imaging. The authors have found that dividing the body of the corpus callosum by exploiting the cleft of the septum pellucidum in the absolute midline is a simple and expeditious way to perform a callosotomy without entering the lateral ventricles.

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