Seizure outcome after corpus callosotomy in a large paediatric series

Background: Epilepsy occurs in up to 90% of patients with Tuberous Sclerosis Complex (TSC) and is often refractory to medications. Our objective was to assess the safety and outcome of epilepsy surgery in children with TSC at our institution. Methods: We performed a systematic, retrospective chart review of children with TSC who underwent epilepsy surgery at our institution. Patients were identified through epilepsy and clinical neurophysiology databases. Results: 19 patients (out of 81 with TSC) underwent surgery between 1995-2014. Median age at surgery was 4.2 (Range 1.1-15.6) years, with patients having failed a median 4 (Range 0-10) anti-seizure medications. Surgery comprised corpus callosotomy in 2 and resection of one or more tubers in 17. 2 patients had a subsequent second resection. Minor neurologic deficits occurred after 14% of surgeries. Median follow-up was 2.4 years (Range 0.3 -13.8 years) following surgery . At last follow-up, 47% were seizure free, including 2 patients off anti-seizure medication. Conclusions: Epilepsy surgery is safe and effective in carefully selected TSC patients, with the majority having a good seizure outcome. Children with epilepsy secondary to TSC should be referred for epilepsy surgery assessment.

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Seizure Outcome after Anterior versus Complete Corpus Callosotomy in Children: A Systematic Review with Meta-Analysis

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0035-1564581 ◽

2015 ◽

Vol 34 (04) ◽

pp. 304-308

Author(s):

Rodrigo Adry ◽

Sebastião Silva Júnior ◽

Carlos Pereira ◽

Jean Oliveira ◽

Dionei Morais ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Seizure Outcome ◽

Corpus Callosotomy

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Seizure Outcomes After Corpus Callosotomy for Drop Attacks

Neurosurgery ◽

10.1227/neu.0000000000000161 ◽

2013 ◽

Vol 73 (6) ◽

pp. 993-1000 ◽

Cited By ~ 30

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.

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Predictive value of MEG using gradient magnetic field topography (GMFT) for seizure outcome following anterior corpus callosotomy (ACC) in patients with drop attacks

Clinical Neurophysiology ◽

10.1016/j.clinph.2015.06.019 ◽

2016 ◽

Vol 127 (1) ◽

pp. 12-14

Author(s):

Stavros I. Dimitriadis

Keyword(s):

Magnetic Field ◽

Predictive Value ◽

Seizure Outcome ◽

Gradient Magnetic Field ◽

Corpus Callosotomy ◽

Drop Attacks

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Corpus Callosotomy for Intractable Epilepsy Revisited: The Children’s Hospital of Michigan Series

Journal of Child Neurology ◽

10.1177/0883073817697847 ◽

2017 ◽

Vol 32 (7) ◽

pp. 624-629 ◽

Cited By ~ 15

Author(s):

Aimee F. Luat ◽

Eishi Asano ◽

Ajay Kumar ◽

Harry T. Chugani ◽

Sandeep Sood

Keyword(s):

Vagus Nerve ◽

Intractable Epilepsy ◽

Endoscopic Approach ◽

Seizure Outcome ◽

Nerve Stimulator ◽

Corpus Callosotomy ◽

Seizure Reduction ◽

Palliative Procedure ◽

Vagus Nerve Stimulator ◽

Drug Resistant Epilepsy

Corpus callosotomy is a palliative procedure performed to reduce the severity of drug-resistant epilepsy. The authors assessed its efficacy on different seizure types in 20 subjects (age range 5-19 years); 8 with active vagus nerve stimulator. Fifteen had complete callosotomy, 3 had anterior 2/3, and 2 had anterior 2/3 followed later by complete callosotomy. Ten had endoscopic approach. In all, 65% had ≥ 50% reduction of generalized seizures leading to falls (atonic, tonic, myoclonic); 35% became seizure-free (follow-up period: 6 months to 9 years; mean 3 years). Seizure outcome distribution was better for generalized than for partial seizures ( P = .003). Endoscopic approach was as effective as transcranial approach. Seven subjects who failed vagus nerve stimulator therapy responded with ≥50% seizure reduction. Corpus callosotomy is an effective treatment for intractable generalized epilepsy leading to falls with significant seizure reduction or even elimination of seizures, in the majority of children.

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Seizure outcome after corpus callosotomy: the Taiwan experience

Child s Nervous System ◽

10.1007/s003810050018 ◽

2000 ◽

Vol 16 (2) ◽

pp. 87-92 ◽

Cited By ~ 26

Author(s):

S. -Y. Kwan ◽

T. -T. Wong ◽

K. -P. Chang ◽

C. -S. Chi ◽

T. -F. Yang ◽

...

Keyword(s):

Seizure Outcome ◽

Corpus Callosotomy

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Complete versus anterior two-thirds corpus callosotomy in children: analysis of outcome

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.5.peds1029 ◽

2010 ◽

Vol 6 (3) ◽

pp. 257-266 ◽

Cited By ~ 39

Author(s):

Laleh Jalilian ◽

David D. Limbrick ◽

Karen Steger-May ◽

Jim Johnston ◽

Alex K. Powers ◽

...

Keyword(s):

Antiepileptic Drugs ◽

Class I ◽

Seizure Outcome ◽

Corpus Callosotomy ◽

Female Ratio ◽

Disconnection Syndrome ◽

Parental Assessment ◽

Initial Procedure ◽

Clinically Significant ◽

Daily Function

Object The goal of this study was to evaluate the efficacy of anterior versus complete sectioning of the corpus callosum in children suffering from medically refractory epilepsy. The authors report seizure outcome in patients who underwent anterior two-thirds or complete corpus callosotomy (CC) during the period 1995–2008 at St. Louis Children's Hospital. Methods The medical records of 27 children and adolescents with a minimum follow-up of 6 months were retrospectively evaluated with respect to seizure status, anticonvulsant outcomes, and subjective results. Preoperatively, patients suffered from a variety of seizure types that occurred daily, weekly, or episodically. The male/female ratio was 19:8, and patients ranged in age between 3 and 19 years (mean 9.93 years). Seizure outcome, parental assessment of daily function, and changes in the number of prescribed antiepileptic drugs were all assessed. Results Fifteen patients underwent an initial anterior two-thirds CC, and 12 underwent a complete CC. Of the 15 patients who underwent an anterior CC, 7 went on to receive a posterior CC. Seizure control was superior in children undergoing a complete CC (91%, Class I–III) versus an anterior two-thirds CC (75%, Class I–III). Seizure types most affected by CC included atonic, myoclonic, and absence. The number of postoperative antiepileptic drugs did not significantly change following CC in either the anterior only or complete groups. One patient experienced a transient disconnection syndrome that resolved within 4 weeks, and 4 patients experienced mild hemiparesis and speech delays that resolved with therapy. Three patients experienced surgical complications requiring a second operation. The overall daily function and attentiveness of the patients improved. Conclusions A complete CC should be considered as the initial procedure in lower-functioning children afflicted by absence, atonic, or myoclonic seizures. Severely affected higher-functioning children may also benefit from a complete CC, without clinically significant disconnection syndromes. A completion posterior CC may benefit patients in whom a prior anterior CC has failed.

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Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: a meta-analysis

Journal of Neurosurgery ◽

10.3171/2017.12.jns172331 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1193-1202 ◽

Cited By ~ 2

Author(s):

Alvin Y. Chan ◽

John D. Rolston ◽

Brian Lee ◽

Sumeet Vadera ◽

Dario J. Englot

Keyword(s):

Meta Analysis ◽

Palliative Surgery ◽

Seizure Outcome ◽

Seizure Freedom ◽

Drug Resistant ◽

Corpus Callosotomy ◽

Mri Findings ◽

Drop Attacks ◽

Drop Attack ◽

Drug Resistant Epilepsy

OBJECTIVECorpus callosotomy is a palliative surgery for drug-resistant epilepsy that reduces the severity and frequency of generalized seizures by disconnecting the two cerebral hemispheres. Unlike with resection, seizure outcomes remain poorly understood. The authors systematically reviewed the literature and performed a meta-analysis to investigate rates and predictors of complete seizure freedom and freedom from drop attacks after corpus callosotomy.METHODSPubMed, Web of Science, and Scopus were queried for primary studies examining seizure outcomes after corpus callosotomy published over 30 years. Rates of complete seizure freedom or drop attack freedom were recorded. Variables showing a potential relationship to seizure outcome on preliminary analysis were subjected to formal meta-analysis.RESULTSThe authors identified 1742 eligible patients from 58 included studies. Overall, the rates of complete seizure freedom and drop attack freedom after corpus callosotomy were 18.8% and 55.3%, respectively. Complete seizure freedom was significantly predicted by the presence of infantile spasms (OR 3.86, 95% CI 1.13–13.23), normal MRI findings (OR 4.63, 95% CI 1.75–12.25), and shorter epilepsy duration (OR 2.57, 95% CI 1.23–5.38). Freedom from drop attacks was predicted by complete over partial callosotomy (OR 2.90, 95% CI 1.07–7.83) and idiopathic over known epilepsy etiology (OR 2.84, 95% CI 1.35–5.99).CONCLUSIONSThe authors report the first systematic review and meta-analysis of seizure outcomes in both adults and children after corpus callosotomy for epilepsy. Approximately one-half of patients become free from drop attacks, and one-fifth achieve complete seizure freedom after surgery. Some predictors of favorable outcome differ from those in resective epilepsy surgery.

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Long-term seizure outcome after corpus callosotomy: a retrospective analysis of 95 patients

Journal of Neurosurgery ◽

10.3171/2008.3.17570 ◽

2009 ◽

Vol 110 (2) ◽

pp. 332-342 ◽

Cited By ~ 77

Author(s):

Taner Tanriverdi ◽

André Olivier ◽

Nicole Poulin ◽

Frederick Andermann ◽

François Dubeau

Keyword(s):

Seizure Type ◽

Seizure Outcome ◽

Corpus Callosotomy ◽

Drop Attacks ◽

Her Family ◽

Long Term Follow Up ◽

Clonic Seizures ◽

Expected Benefits

Object The authors report long-term follow-up seizure outcome in patients who underwent corpus callosotomy during the period 1981–2001 at the Montreal Neurological Institute. Methods The records of 95 patients with a minimum follow-up of 5 years (mean 17.2 years) were retrospectively evaluated with respect to seizure, medication outcomes, and prognostic factors on seizure outcome. Results All patients had more than one type of seizure, most frequently drop attacks and generalized tonicclonic seizures. The most disabling seizure type was drop attacks, followed by generalized tonic-clonic seizures. Improvement was noted in several seizure types and was most likely for generalized tonic-clonic seizures (77.3%) and drop attacks (77.2%). Simple partial, generalized tonic, and myoclonic seizures also benefited from anterior callosotomy. The extent of the callosal section was correlated with favorable seizure outcome. The complications were mild and transient and no death was seen. Conclusions This study confirms that anterior callosotomy is an effective treatment in intractable generalized seizures that are not amenable to focal resection. When considering this procedure, the treating physician must thoroughly assess the expected benefits, limitations, likelihood of residual seizures, and the risks, and explain them to the patient, his or her family, and other caregivers.

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