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Corpus callosotomy in refractory idiopathic generalized epilepsy
Journal article   Open access   Peer reviewed

Corpus callosotomy in refractory idiopathic generalized epilepsy

Sigmund Jenssen, Michael R. Sperling, Joseph I. Tracy, Maromi Nei, Liporace Joyce, Glosser David and Michael O’Connor
Seizure (London, England), v 15(8), pp 621-629
2006
DOI: https://doi.org/10.1016/j.seizure.2006.09.003
PMID: 17067824
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.seizure.2006.09.003View
Published, Version of Record (VoR)Open Access (Publisher-Specific),  Open

Abstract

Absence seizures Corpus callosotomy Corpus callosum Epilepsy Generalized tonic–clonic seizures Idiopathic generalized epilepsy Myoclonus seizures Neuropsychology Neurosurgery Refractory
A small percentage of patients with idiopathic generalized epilepsy (IGE) do not respond to medical therapy. Generalized tonic–clonic (GTC) seizures are especially debilitating and can be associated with severe injuries. The benefit, safety and effect of corpus callosotomy (CC) in patients with IGE have not been studied. We reviewed patients with presumed IGE who underwent CC between 1991 and 2000. Criteria for selection included history, examination, brain imagining, interictal and ictal EEG. All patients had refractory and debilitating tonic–clonic seizures (GTCS) and had failed four or more antiepileptic drugs. Seizure frequency was calculated per month over the last year and pre-operative baseline was compared to last follow-up using paired t-tests. IQ, executive function, language and verbal, non-verbal memory and quality of life (QOL) was compared before and after surgery. Serial EEGs after surgery were reviewed. There were nine patients (seven men), mean age 37.9 (range: 22–49), mean IQ 87.3 (range: 75–107). All had anterior CC. Mean follow-up time was 5.4 years (range: 0.6–10.3 years). One patient died from sudden death in epilepsy 9 months after surgery. There was a significant reduction of GTC seizures from 6.3 to 1.1 ( p < 0.005). Four patients had more than 80% and eight more than 50% reduction. Of five patients with absence seizures, two became seizure free and one had more than 80% reduction and two worsened slightly, and of three with myoclonic seizures one had more than 90% reduction. One patient had completion of the CC with improvement of myoclonus and absence seizures, but not of GTC seizures and suffered a disconnection syndrome. Another had right frontal focal resection without improvement after new seizures of focal onset. Cognitive testing showed a good outcome (improved or no change) in all cognitive domains. Post-surgical EEG showed new focal slowing and sharp waves. There was no change in QOL. CC can be effective in reducing GTC, absence and myoclonic seizures in patients with refractory IGE. These findings suggest that interhemispheric communication of the cerebral cortices plays an important role in the generation of seizures in IGE. Anterior CC appears safe while complete callosotomy has a risk of disconnection syndrome.

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Web of Science research areas
Clinical Neurology
Neurosciences
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