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McLaren JR, Kahle KT, Richardson RM, Chu CJ. Epilepsy Surgery for Cognitive Improvement in Epileptic Encephalopathy. Neurosurg Clin N Am 2024; 35:49-59. [PMID: 38000841 DOI: 10.1016/j.nec.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Epileptic encephalopathies are defined by the presence of frequent epileptiform activity that causes neurodevelopmental slowing or regression. Here, we review evidence that epilepsy surgery improves neurodevelopment in children with epileptic encephalopathies. We describe an example patient with epileptic encephalopathy without drug refractory seizures, who underwent successful diagnostic and therapeutic surgeries. In patients with epileptic encephalopathy, cognitive improvement alone is a sufficient indication to recommend surgical intervention in experienced centers.
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Affiliation(s)
- John R McLaren
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School
| | - Kristopher T Kahle
- Harvard Medical School; Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Wang Building Room 333, Boston, MA 02114, USA
| | - R Mark Richardson
- Harvard Medical School; Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Their Building, 4th Floor, Boston, MA 02114, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School.
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2
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Liu Y, Zhang J, Ren Y, Wu H, Li H, Dong S, Liu X, Du C, Meng Q, Zhang H. The clinical features of patients with seizure freedom and failure after total corpus callosotomy for childhood-onset refractory epilepsy. Br J Neurosurg 2023:1-8. [PMID: 37927066 DOI: 10.1080/02688697.2023.2273840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Corpus callosotomy is a palliative surgery for medically refractory epilepsy. We aim to analyze the clinical features of patients with seizure freedom and failure after total corpus callosotomy for childhood-onset refractory epilepsy. METHODS We retrospectively reviewed the clinical courses of patients with childhood-onset refractory epilepsy undergoing total corpus callosotomy between May 2009 and March 2019. Seizure outcome at the last follow-up was the primary outcome. The clinical features of patients with seizure freedom and failure after callosotomy were compared. RESULTS Eighty patients with childhood-onset refractory epilepsy underwent total corpus callosotomy; 15 (18.8%) obtained freedom from all seizures and 19 (23.8%) had unworthwhile improvement and failure. The mean ages at seizure onset in patients with seizure freedom and failure after callosotomy were 5.7 and 5.9 years; and mean seizure durations were 9.4 and 11.5 years, respectively. Univariate analysis found epilepsy syndrome (p = 0.047), mental retardation (p = 0.007), previous medical history (p = 0.004), ≥10 seizures per day (p = 0.024), theta waves in the background electroencephalogram (p = 0.024), and acute postoperative seizure (p = 0.000) were associated with failure after callosotomy. Seizure freedom after callosotomy was more common among patients with less than 10 seizures per day. CONCLUSIONS Total corpus callosotomy is an effective palliative procedure for childhood-onset refractory epilepsy, particularly for patients with specific clinical characteristics. Callosotomy has a high seizure-free rate in well-selected patients.
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Affiliation(s)
- Yong Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Jiale Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Yutao Ren
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Hao Wu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Huanfa Li
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Shan Dong
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Xiaofang Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Changwang Du
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Qiang Meng
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Hua Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
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3
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Wu X, Ou S, Zhang H, Zhen Y, Huang Y, Wei P, Shan Y. Long-term follow-up seizure outcomes after corpus callosotomy: A systematic review with meta-analysis. Brain Behav 2023; 13:e2964. [PMID: 36929636 PMCID: PMC10097058 DOI: 10.1002/brb3.2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Corpus callosotomy (CC) is appropriate for patients with seizures of a bilateral or diffuse origin, or those with seizures of a unilateral origin with rapid spread to the contralateral cerebral hemisphere. The efficiency of CC in patients with drug-resistant epilepsy is a long-term concern because most articles reporting the surgical results of CC arise from small case series, and the durations of follow-up vary. METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched to identify papers published before November 8, 2021. The systematic review was completed following PRISMA guidelines. Outcomes were analyzed by meta-analysis of the proportions. RESULTS A total of 1644 patients with drug-resistant epilepsy (49 retrospective or prospective case series studies) underwent CC, and the follow-up time of all patients was at least 1 year. The rate of complete seizure freedom (SF) was 12.38% (95% confidence interval [CI], 8.17%-17.21%). Meanwhile, the rate of complete SF from drop attacks was 61.86% (95% CI, 51.87%-71.41%). The rates of complete SF after total corpus callosotomy (TCC) and anterior corpus callosotomy (ACC) were 11.41% (95% CI, 5.33%-18.91%) and 6.75% (95% CI, 2.76%-11.85%), respectively. Additionally, the rate of complete SF from drop attacks after TCC was significantly higher than that after ACC (71.52%, 95% CI, 54.22%-86.35% vs. 57.11%, 95% CI, 42.17%-71.49%). The quality of evidence for the three outcomes by GRADE assessment was low to moderate. CONCLUSION There was no significant difference in the rate of complete SF between TCC and ACC. TCC had a significantly higher rate of complete SF from drop attacks than did ACC. Furthermore, CC for the treatment of drug-resistant epilepsy remains an important problem for further investigation because there are no universally accepted standardized guidelines for the extent of CC and its benefit to patients. In future research, we will focus on this issue.
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Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China.,Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Siqi Ou
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China.,Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Huaqiang Zhang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China.,Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Yuhang Zhen
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China.,Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Yinchun Huang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China.,Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China.,Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China.,Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
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Ukishiro K, Osawa SI, Iwasaki M, Kakisaka Y, Jin K, Uematsu M, Yamamoto T, Tominaga T, Nakasato N. Age-Related Recovery of Daily Living Activity After 1-Stage Complete Corpus Callosotomy: A Retrospective Analysis of 41 Cases. Neurosurgery 2022; 90:547-551. [PMID: 35129138 DOI: 10.1227/neu.0000000000001871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in younger patients. OBJECTIVE To evaluate the relationship between patient age and recovery time of activities of daily living (ADL) after 1-stage complete CC. METHODS This study included 41 patients (22 women; aged 13 months-34 years, median 7 years) who underwent 1-stage complete CC for medically intractable seizures with drop attacks, infantile spasms, and/or bilaterally synchronized electroencephalographic discharges between August 2009 and April 2019. The timing of restart of competence in 5 ADL categories and surgical outcomes were recorded. RESULTS Patients (1) restarted speech at 2.2 ± 1.3 (mean ± 2 standard deviations; range 1-5) days, (2) restarted replying with their own name on request at 5.5 ± 8.6 (2-33) days, (3) restarted oral intake at 1.6 ± 1.7 (1-11) days, (5) discontinued intravenous feeding at 6.0 ± 3.0 (2-16) days, and (5) restarted ambulation or wheelchair movement at 5.8 ± 3.4 (2-10) days. Younger patients showed significantly (P < .0223) earlier recovery of ambulation or wheelchair movement, but no age difference was found in the other 4 ADL categories. Overall seizure freedom was achieved in 5 patients, excellent (>80%) seizure reduction in 11, good (50%-80%) seizure reduction in 5, and poor (<50%) seizure reduction in 20. CONCLUSION Early ADL recovery after 1-stage complete CC is favorable in both young and adult patients. These findings, with good surgical outcomes, will encourage more positive consideration of 1-stage complete CC in both pediatric and adult patients.
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Affiliation(s)
- Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
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5
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Corpus Callosotomy in the Modern Era: Origins, Efficacy, Technical Variations, Complications, and Indications. World Neurosurg 2022; 159:146-155. [PMID: 35033693 DOI: 10.1016/j.wneu.2022.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 11/23/2022]
Abstract
Corpus callosotomy is among the oldest surgeries performed for drug-resistant epilepsy (DRE). First performed in 1940, various studies have since assessed its outcomes in various patient populations in addition to describing different extents of sectioning and emerging technologies (i.e. endoscopic, laser interstitial thermal therapy, and radiosurgery). In order to capture the current state and offer a reappraisal, we comprehensively review corpus callosotomy's origins, efficacy for various seizure types, technical variations, complications, and indications and compare the procedure to vagus nerve stimulation therapy which has similar indications. We consider corpus callosotomy to be a safe and efficacious procedure that should be considered by clinicians when appropriate. Furthermore, it can also play an important role in treating patients with DRE in low-to-middle-income countries where resources are limited.
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6
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Epilepsy Surgery is a Viable Treatment for Lennox Gastaut Syndrome. Semin Pediatr Neurol 2021; 38:100894. [PMID: 34183143 DOI: 10.1016/j.spen.2021.100894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022]
Abstract
Lennox Gastaut Syndrome (LGS) is a severe developmental epileptic encephalopathy with onset in childhood characterized by multiple seizure types and characteristic electroencephalogram findings. The majority of patients develop drug resistant epilepsy, defined as failure of 2 appropriate anti-seizure medications used at adequate doses. Epilepsy surgery can reduce seizure burden, in some cases leading to seizure freedom, and improve neuro-developmental outcomes and quality of life. Epilepsy surgery should be considered for all patients with drug resistant LGS. Herein, we review current surgical treatment options for patients with LGS, both definitive and palliative, including: focal cortical resection, vagus nerve stimulation and corpus callosotomy. Newer neuromodulation techniques will be explored, as well as the concept of LGS as a secondary network disorder.
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7
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Ye VC, Mansouri A, Warsi NM, Ibrahim GM. Atonic seizures in children: a meta-analysis comparing corpus callosotomy to vagus nerve stimulation. Childs Nerv Syst 2021; 37:259-267. [PMID: 32529546 DOI: 10.1007/s00381-020-04698-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Atonic seizures are associated with a particularly poor response to medical treatment. We performed a systematic review and meta-analysis to compare the efficacy of corpus callosotomy (CC) and vagus nerve stimulation (VNS) in the management of atonic seizures in the pediatric population. METHODS A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations, focusing on atonic seizures, CC, and VNS in pediatric populations. Pertinent clinical data were extracted and analyzed. Pooled effects between groups were calculated as standardized error (SE) with 95% confidence intervals (CIs). To assess for statistical significance, the Z-test was performed, using the pooled effect size (ES) and 95% CI for each intervention. RESULTS A total of 31 studies met the inclusion criteria, with 24 studies encompassing 425 children treated with CC and 7 studies encompassing 108 children treated with VNS. Twenty-four studies were included in a meta-analysis. There was a statistically significant difference in the primary outcome of atonic seizure control in favor of CC (overall effect size (ES) 0.73, 95% CI 0.69-0.77 for CC, ES 0.4, 95% CI 0.28-0.51 for VNS, p = 0.003). There was a higher rate of complications requiring reoperation in the CC cohort (6.6% vs. 3.8%) and a 14% rate of symptomatic disconnection syndrome. CONCLUSIONS While both techniques are safe, CC provides a much higher chance of effectively managing this morbid seizure type albeit with a higher risk of re-operation and disconnection syndrome.
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Affiliation(s)
- Vincent C Ye
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Pennsylvania State University, Hershey, PA, USA
| | - Nebras M Warsi
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - George M Ibrahim
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada.
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
- Program in Neurosciences and Mental Health Research Institute, Department of Surgery, Institute of Biomaterials and Biomedical Engineering, The University of Toronto, Toronto, Canada.
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8
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Management of Lennox-Gastaut syndrome beyond childhood: A comprehensive review. Epilepsy Behav 2021; 114:107612. [PMID: 33243685 DOI: 10.1016/j.yebeh.2020.107612] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
Lennox-Gastaut syndrome (LGS) is a childhood-onset epileptic encephalopathy characterized by multiple types of medically intractable seizures, cognitive impairment, and generalized slow spike-wave discharges in electroencephalography (EEG). Although the onset of this epileptic syndrome occurs typically before eight years of age with a peak age between 3 and 5 years, lifelong persistence of the syndrome is usual. The evolution of clinical features, EEG findings, and paucity of knowledge about LGS among adult health care providers can make LGS significantly underdiagnosed in the adult population. Management of LGS remains problematic beyond childhood due to intractable seizures, the difficult transition from pediatric to adult neurologists, challenging behaviors, impaired cognition, poor quality of life, and disabled social life. In focusing on the management of LGS beyond childhood, this narrative review describes medical and surgical management of epilepsy, the transition from pediatric to adult care, and management of other common comorbidities associated with LGS. Several antiepileptic drugs (AEDs) such as lamotrigine, topiramate, felbamate, rufinamide, clobazam, and Epidiolex (pure pharmaceutical grade cannabidiol (CBD) oil) have been noted to be effective in well-designed, randomized controlled trials. Other non-pharmacological therapies, such as vagus nerve stimulation, ketogenic diet, and epilepsy surgery, have been frequently utilized in the management of intractable seizures associated with LGS. However, effective management of LGS requires a broader perspective to not only control seizures but improve the quality of life by addressing cognitive and behavioral problems, sleep disturbances, physical disability, social disability, and educational and employment challenges.
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Tao JX, Satzer D, Issa NP, Collins J, Wu S, Rose S, Henry J, Santos de Lima F, Nordli D, Warnke PC. Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome. Epilepsia 2020; 61:1190-1200. [DOI: 10.1111/epi.16535] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/27/2022]
Affiliation(s)
- James X. Tao
- Department of Neurology University of Chicago Chicago IL USA
| | - David Satzer
- Department of Neurosurgery University of Chicago Chicago IL USA
| | - Naoum P. Issa
- Department of Neurology University of Chicago Chicago IL USA
| | - John Collins
- Department of Radiology University of Chicago Chicago IL USA
| | - Shasha Wu
- Department of Neurology University of Chicago Chicago IL USA
| | - Sandra Rose
- Department of Neurology University of Chicago Chicago IL USA
| | - Julia Henry
- Department of Pediatrics University of Chicago Chicago IL USA
| | | | - Douglas Nordli
- Department of Pediatrics University of Chicago Chicago IL USA
| | - Peter C. Warnke
- Department of Neurosurgery University of Chicago Chicago IL USA
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Duc Lien N, Tuan DA, Vu Hung C, Lepard JR, Rocque BG. Corpus callosotomy for treatment of drug-resistant epilepsy: a review of 16 pediatric cases in northern Vietnam. J Neurosurg Pediatr 2020; 25:582-587. [PMID: 32109876 DOI: 10.3171/2019.12.peds19638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate postoperative seizure outcome in children with drug-resistant epilepsy not eligible for focal resection who underwent corpus callosotomy. METHODS The study included 16 patients undergoing corpus callosotomy between September 2015 and May 2018. Seizure semiology and frequency, psychomotor status, and video electroencephalography and imaging findings were evaluated for all patients. RESULTS Of the 16 patients who underwent callosotomy during the study period, 11 underwent complete callosotomy and 5 underwent anterior only. Seizure improvement greater than 75% was achieved in 37.5% of patients, and another 50% of patients had seizure improvement of 50%-75%. No sustained neurological deficits were observed in these patients. There were no significant complications. Duration of postoperative follow-up ranged from 12 to 44 months. CONCLUSIONS Corpus callosotomy is an effective treatment for selected patients with drug-resistant epilepsy not eligible for focal resection in resource-limited settings. Fostering and developing international epilepsy surgery centers should remain a high priority for the neurosurgical community at large.
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Affiliation(s)
- Nguyen Duc Lien
- 1Neurosurgical Department, Vietnam National Cancer Hospital, Hanoi
| | - Dang Anh Tuan
- 2Neurology Department, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Cao Vu Hung
- 2Neurology Department, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Jacob R Lepard
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
- 4The Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Brandon G Rocque
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
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11
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Borrelli S, El Tahry R. Therapeutic approach to Lennox-Gastaut syndrome: a systematic review. Acta Neurol Belg 2019; 119:315-324. [PMID: 31286465 DOI: 10.1007/s13760-019-01185-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/02/2019] [Indexed: 01/18/2023]
Abstract
Lennox-Gastaut syndrome (LGS) is a rare, age-related syndrome, characterized by multiple seizure types, mental regression, and specific EEG abnormalities. It is one of the most challenging epilepsy: treatment is rarely effective and the final prognosis remains poor, despite the availability of several antiepileptic drugs, validated through well-designed, randomized, controlled trials. However, it is reasonable to consider non-medical treatments, such as surgery, after failure of two-to-three drugs. This review has as goal to describe systematically the different therapeutic options for LGS, including, not only recognized antiepileptic drugs, but also new oral drugs, immune therapy, diet, surgery, and neurostimulation techniques.
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Affiliation(s)
- Serena Borrelli
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium.
| | - Riem El Tahry
- Department of Neurology, Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
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12
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Chan AY, Rolston JD, Lee B, Vadera S, Englot DJ. Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: a meta-analysis. J Neurosurg 2018:1-10. [PMID: 29999448 DOI: 10.3171/2017.12.jns172331] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/23/2017] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Alvin Y Chan
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John D Rolston
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Brian Lee
- 3Department of Neurological Surgery, University of Southern California, Los Angeles
| | - Sumeet Vadera
- 4Department of Neurological Surgery, University of California, Irvine, California; and
| | - Dario J Englot
- 5Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
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Taraschenko O, Pedavally S, Samson KK, Puccioni MJ, Madhavan D. Anterior corpus callosotomy in patients with drug-resistant epilepsy: Invasive EEG findings and seizure outcomes. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 9:12-18. [PMID: 29692963 PMCID: PMC5913038 DOI: 10.1016/j.ebcr.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/17/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Abstract
Corpus callosotomy (CC) is used in patients with drug-resistant seizures who are not candidates for excisional surgery and failed neurostimulation. We examined ictal scalp and intracranial electroencephalogram (iEEG) recordings in 16 patients being evaluated for anterior CC alone or CC in combination with focal resection, to determine the role of the iEEG in predicting postoperative seizure outcomes. In our cohort, CC improved generalized atonic seizures and focal seizures with impaired awareness but did not alter outcomes for generalized tonic–clonic or tonic seizures. Invasive EEG prior to CC did not refine the prediction of postsurgical seizure outcomes in patients with inconclusive scalp EEG. Patients with drug-resistant epilepsy achieved a significant reduction of generalized atonic and focal seizures with impaired awareness following corpus callosotomy. The age at epilepsy diagnosis or structural pathology identified on the imaging did not predict postoperative seizure status. The ictal findings on invasive EEG prior to corpus callosotomy improved lateralization of seizure onset but did not predict seizure outcomes.
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Affiliation(s)
- Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
- Corresponding author at: Comprehensive Epilepsy Program, Department of Neurological Sciences, University of Nebraska Medical Center, 988435 Nebraska Medical Center, Omaha, NE 68198-8435, United States.
| | - Swetha Pedavally
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kaeli K. Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Mark J. Puccioni
- Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Deepak Madhavan
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
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Abstract
Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20-30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal-seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.
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Affiliation(s)
- Jian Guan
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Michael Karsy
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Katrina Ducis
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Robert J Bollo
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
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Rolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF. Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: A systematic review. Epilepsy Behav 2015; 51:13-7. [PMID: 26247311 PMCID: PMC5261864 DOI: 10.1016/j.yebeh.2015.06.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
Atonic seizures are debilitating and poorly controlled with antiepileptic medications. Two surgical options are primarily used to treat medically refractory atonic seizures: corpus callosotomy (CC) and vagus nerve stimulation (VNS). However, given the uncertainty regarding relative efficacy and surgical complications, the best approach for affected patients is unclear. The PubMed database was queried for all articles describing the treatment of atonic seizures and drop attacks with either corpus callosotomy or VNS. Rates of seizure freedom, >50% reduction in seizure frequency, and complications were compared across the two patient groups. Patients were significantly more likely to achieve a >50% reduction in seizure frequency with CC versus VNS (85.6% versus 57.6%; RR: 1.5; 95% CI: 1.1-2.1). Adverse events were more common with VNS, though typically mild (e.g., 22% hoarseness and voice changes), compared with CC, where the most common complication was the disconnection syndrome (13.2%). Both CC and VNS are well tolerated for the treatment of refractory atonic seizures. Existing studies suggest that CC is potentially more effective than VNS in reducing seizure frequency, though a direct study comparing these techniques is required before a definitive conclusion can be reached.
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Affiliation(s)
- John D. Rolston
- Department of Neurological Surgery, University of CA, San Francisco, USA,Corresponding author at: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, CA 94143-0112, USA. Tel.: + 1 415 353 7500. (J.D. Rolston)
| | - Dario J. Englot
- Department of Neurological Surgery, University of CA, San Francisco, USA
| | - Doris D. Wang
- Department of Neurological Surgery, University of CA, San Francisco, USA
| | - Paul A. Garcia
- Department of Neurology, University of CA, San Francisco, USA
| | - Edward F. Chang
- Department of Neurological Surgery, University of CA, San Francisco, USA
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Douglass LM, Salpekar J. Surgical options for patients with Lennox-Gastaut syndrome. Epilepsia 2014; 55 Suppl 4:21-8. [DOI: 10.1111/epi.12742] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Laurie M. Douglass
- Boston Medical Center; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Jay Salpekar
- Kennedy Krieger Institute; Baltimore Maryland U.S.A
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Yang PF, Lin Q, Mei Z, Chen ZQ, Zhang HJ, Pei JS, Tian J, Jia YZ, Zhong ZH. Outcome after anterior callosal section that spares the splenium in pediatric patients with drop attacks. Epilepsy Behav 2014; 36:47-52. [PMID: 24857808 DOI: 10.1016/j.yebeh.2014.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
We report on the efficacy and safety of extended, one-stage anterior callosal section that spares the splenium, which is performed in a large series of pediatric patients with drop attacks. Twenty-nine pediatric patients with drop attacks were studied (19 males and 10 females; mean age: 9.9 years). As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron emission tomography abnormalities were analyzed. All patients had multiple seizure types, including drop attacks, atypical absence seizures, complex partial seizures, tonic seizures, and generalized tonic-clonic seizures. All patients were developmentally impaired and had electroencephalograph results showing marked secondary bilateral synchrony. All patients received an extended, one-stage callosal section, leaving only the splenium intact. The mean follow-up time was 5.2 years. Seizure outcome (cessation of seizures or ≥ 90% seizure reduction) was achieved in 79.3% of patients with drop attacks. The families assessed the overall daily function as improved in 62.1% of the patients, unchanged in 24.1%, and worse in 13.8%. Family satisfaction with callosotomy was achieved in 82.8% of the patients. The majority of the patients had some degree of a transient acute postoperative disconnection syndrome that disappeared within 3 weeks. Postoperatively, patients showed a consistent increase in attention levels. We conclude that extended callosal sectioning that leaves the splenium intact should be considered a good palliative surgical option for pediatric patients with drop attacks and that diminishment of epileptic discharge synchrony is a good prognostic sign following callosotomy. We also found that the postoperative increase in attention levels was as useful as seizure control in improving the quality of life of these patients.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhen Mei
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zi-Qian Chen
- Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Hui-Jian Zhang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jun Tian
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
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Moseley BD, Nickels K, Wirrell EC. Surgical outcomes for intractable epilepsy in children with epileptic spasms. J Child Neurol 2012; 27:713-20. [PMID: 22123426 DOI: 10.1177/0883073811424463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epileptic spasms, or seizures marked by flexor, extensor, or flexor-extensor spasms, are not always responsive to medical management. The purpose of our study was to evaluate the outcome of epilepsy surgery in children with medically intractable epileptic spasms. We identified 11 children with epileptic spasms who underwent lesionectomy (36%), lobectomy (27%), multi-lobectomy (9%), hemispherectomy (18%), or corpus callosotomy (9%). At the time of surgery, 6 children had developed other concurrent seizure type(s), including simple partial (9%), complex partial (27%), partial undifferentiated (9%), primary generalized tonic clonic (9%), tonic (9%), atonic (27%), and myoclonic (9%) seizures. Six children (55%) were seizure free at last follow-up from initial surgery. Predictors of favorable outcome included lack of focal slowing and the presence of less than 2 interictal epileptiform abnormalities on postoperative electroencephalogram (P = .035 and .035, respectively). Favorable outcome was significantly associated with parent/caregiver report of improved postoperative developmental outcomes (P = .026).
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Affiliation(s)
- Tai-Tong Wong
- Pediatric Neurosurgery Neurological Institute, Veterans General Hospital, Taipei, Taiwan.
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Jalilian L, Limbrick DD, Steger-May K, Johnston J, Powers AK, Smyth MD. Complete versus anterior two-thirds corpus callosotomy in children: analysis of outcome. J Neurosurg Pediatr 2010; 6:257-66. [PMID: 20809710 DOI: 10.3171/2010.5.peds1029] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Laleh Jalilian
- Washington University in St. Louis School of Medicine, St. Louis, Missouri 63110-1077, USA
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Ping Z, Ji-Wen X, Gui-Song W, Hong-Yu Z, Xin T. Evaluation of efficacy and safety of anterior corpus callosotomy with keyhole in refractory seizures. Seizure 2009; 18:417-9. [PMID: 19410486 DOI: 10.1016/j.seizure.2009.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 03/13/2009] [Accepted: 03/20/2009] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to evaluate the efficacy and safety of anterior corpus callosotomy with a keyhole approach on refractory seizures and to evaluate this procedure for drop attacks (DAs) and generalized tonic-clonic seizures (GTCSs). METHODS All refractory seizure patients underwent anterior corpus callosotomy (n=31) without other epilepsy surgery. Seizure response and procedure complications were evaluated. RESULTS Seizure types included GTCS (n=26), and atonic or tonic seizures with DA (n=9). In GTCS patients, 84.6% had >or=50% decrease in seizure frequency, and 61.5% had >or=80% reduction. In DA patients, 77.8% had >or=50% decrease in seizure frequency, and 55.6% had >or=80% reduction. There were no statistically significant differences between the groups in final efficacy. Overall complication rate for corpus callosotomy was 12.9%, the permanent complication rate was 3.2%. CONCLUSIONS Anterior corpus callosotomy with a keyhole approach produces highly favorable outcomes for both GTCS and atonic or tonic seizures with a low risk for complications.
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Affiliation(s)
- Zheng Ping
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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Tanriverdi T, Olivier A, Poulin N, Andermann F, Dubeau F. Long-term seizure outcome after corpus callosotomy: a retrospective analysis of 95 patients. J Neurosurg 2009; 110:332-42. [DOI: 10.3171/2008.3.17570] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
| | | | | | - Frederick Andermann
- 2Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- 2Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Rathore C, Abraham M, Rao RM, George A, Sankara Sarma P, Radhakrishnan K. Outcome after corpus callosotomy in children with injurious drop attacks and severe mental retardation. Brain Dev 2007; 29:577-85. [PMID: 17507193 DOI: 10.1016/j.braindev.2007.03.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 01/21/2007] [Accepted: 03/20/2007] [Indexed: 11/23/2022]
Abstract
Wide variability in patient selection, extent of callosal section and definition of successful outcome between studies make impact of corpus callosotomy on patients with medically refractory epilepsies difficult to interpret. Severe mental retardation is considered to be predictive of unfavorable seizure outcome after callosotomy. Very little attention has been paid on the influence of callosotomy on the psychosocial burden on the patients' families. We evaluated the seizure outcome, and parental perception about change in cognition and behavior of 17 children (median age 9.5 years, range 3.5-18 years) with severe mental retardation (IQ<30 in all, except one) and injurious drop attacks, who have completed >or=1-year postoperative follow-up after callosotomy. Nearly two-thirds of our patients had >or=90% reduction in drop attacks and generalized tonic-clonic seizures. In the one-stage total callosotomy group, 9 of 11 (82%) patients had favorable outcome, compared to 2 of the 6 (33%) in the partial callosotomy group. Absence of generalized epileptiform discharges on the 1-year postoperative EEG was significantly associated with a favorable seizure outcome. The mean duration of epilepsy prior to callosotomy tended to be shorter among patients with favorable seizure outcome. Postoperative complications were trivial and transient. Nearly three-fourths of the parents appreciated improvements in behavior and attentiveness of their children and were satisfied with the outcome. We conclude that, in children with severe mental retardation and injurious drop attacks, total callosotomy can be undertaken as a one-stage procedure with insignificant morbidity and results in highly favorable seizure outcome.
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Affiliation(s)
- Chaturbhuj Rathore
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Smyth MD, Klein EE, Dodson WE, Mansur DB. Radiosurgical posterior corpus callosotomy in a child with Lennox–Gastaut syndrome. J Neurosurg Pediatr 2007; 106:312-5. [PMID: 17465368 DOI: 10.3171/ped.2007.106.4.312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the successful use of radiosurgery in a child for posterior corpus callosotomy; the early results are good and the patient has not suffered any morbid conditions. The relevant literature pertaining to the use of radiosurgery for treating epilepsy is reviewed. Details of the radiosurgical techniques and prescription dose used are presented, along with 1-year serial neuroimaging results.
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Affiliation(s)
- Matthew D Smyth
- Department of Neurological Surgery, Washington University, St. Louis Children's Hospital, Missouri 63110, USA.
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Kwan SY, Lin JH, Wong TT, Chang KP, Yiu CH. A comparison of seizure outcome after callosotomy in patients with Lennox-Gastaut syndrome and a positive or negative history for West syndrome. Seizure 2006; 15:552-7. [PMID: 16884930 DOI: 10.1016/j.seizure.2006.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2005] [Revised: 06/17/2006] [Accepted: 06/28/2006] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This retrospective study was designed to clarify the role of West syndrome in post-callosotomy seizure outcome in patients with Lennox-Gastaut syndrome. METHODS From September 1989 to May 1999, 74 patients diagnosed with Lennox-Gastaut syndrome received anterior corpus callosotomy at Taipei Veterans General Hospital, Taiwan. All patients were followed for more than 4 years after surgery. Among them, 21 (28.4%) patients had a history of West syndrome (Group A) whereas 53 (71.6%) patients did not have a history of West syndrome (Group B). Postoperative seizure outcome was compared for these two patient groups. RESULTS A total of 16 (76.2%) patients in Group A (positive history) and 29 (54.7%) patients in group B (negative history) achieved significant improvement in seizures after surgery (e.g., seizure reduction of more than 50%). There was no statistical significance (p=0.088) in the difference in outcome between the two groups. CONCLUSIONS A history of West syndrome does not appear to influence post-callosotomy seizure outcome in patients with Lennox-Gastaut syndrome.
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Affiliation(s)
- Shang-Yeong Kwan
- Pediatric Epilepsy Surgery Group, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Wong TT, Kwan SY, Chang KP, Hsiu-Mei W, Yang TF, Chen YS, Yi-Yen L. Corpus callosotomy in children. Childs Nerv Syst 2006; 22:999-1011. [PMID: 16830167 DOI: 10.1007/s00381-006-0133-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Indexed: 11/24/2022]
Abstract
INTRODUCTION For children of medical resistant epilepsy without resectable epileptogenic zone, corpus callosotomy and vagus nerve stimulation (VNS) therapy are the two commonly used palliative epilepsy surgeries that can be considered. Although their routes and mechanisms to control epilepsy are different, both surgeries have shown their efficacy in selected candidates. The most common candidates for palliative surgery are in infants and children with organic encephalopathic types of epilepsy including infantile spasms/West syndrome, Lennox-Gastaut syndrome (LGS), severe epilepsy with multiple independent spike foci (SE-MISF) and selected symptomatic partial epilepsy to relief seizures and to stabilize co morbidities (Hirsch and Arzimanoglou, Revue Neurologique [Hirsch E and Arzimanoglou A, Rev Neurol (Paris). 160 Spec No 1:5S210-S219, (2004); Ohtahara S and Yamatogi Y, J Clin Neurophysiol 20(6):398-407, (2003); Wheless JW and Epilepsia 45(Suppl 5):17-22, (2004); Trevathan E, J Child Neurol 17 Suppl 2:2S9-2S22, (2002)]. DISCUSSION Callosotomy is a major and destructive but affordable surgical procedure as compare to the relative simple but costly extracranial procedure of VNS therapy. However, callosotomy is a safe and effective palliative operation in neurosurgeons familiar with the surgical procedure. Equipments for callosotomy can be as simple as headlight and binocular loupes, self-retention brain retractor, bipolar cauterization, and simple microinstruments.
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Affiliation(s)
- Tai-Tong Wong
- Pediatric Epilepsy Surgery Group, Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, VACRS, No. 210, Sec 2, Shih-Pai, 11217, Taipei, Taiwan, Republic of China.
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Kamida T, Maruyama T, Fujiki M, Kobayashi H, Izumi T, Baba H. Total callosotomy for a case of lissencephaly presenting with West syndrome and generalized seizures. Childs Nerv Syst 2005; 21:1056-60. [PMID: 15654631 DOI: 10.1007/s00381-004-1081-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Indexed: 11/30/2022]
Abstract
CASE REPORT An 11-month-old girl had an onset of oculogyric crisis at 2 months and she presented with epileptic spasms and generalized tonic seizures with series formation at 3 months. Her seizures were medically intractable and her development had gradually regressed after that. MRI showed severe lissencephaly in bilateral hemispheres. Interictal EEG showed hypsarrhythmia periodically and sporadic spike waves in the right hemisphere. The generalized tonic seizures began with bi-frontal polyspikes on EEG. Our diagnosis was lissencephaly presenting with West syndrome and generalized tonic seizures. A total callosotomy was performed at 11 months. OUTCOME Postoperative frequency of seizures decreased prominently and developmental progression was resumed. CONCLUSIONS This case showed that the corpus callosum may play an important role in some types of symptomatic West syndrome. Corpus callosotomy for treating symptomatic West syndrome should be considered as an option after careful selection and consideration of the timing of surgery.
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Affiliation(s)
- T Kamida
- Department of Neurosurgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.
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Guénot M. Indications et risques des techniques neuro-chirurgicales chez l’enfant présentant une épilepsie partielle pharmaco-résistante. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71201-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Callosotomy has played a unique role in the treatment of epilepsy and in the understanding of human brain function. The pioneering work of Dejerine and Liepmann presenting the first findings of callosal lesion pathology at the turn of the 20th century was accepted but then quickly forgotten. Two schools resurrected the phoenix of callosal syndromes: Roger Sperry and Michael Gazzaniga leading in experimental neuroscience, and Norman Geschwind leading in clinical neurology. Callosotomy remains an effective technique to treat atonic, tonic, and tonic-clonic seizures, especially in patients with symptomatic generalized epilepsies such as Lennox-Gastaut syndrome. Neurologic, cognitive, and behavioral complications limit its use given that precise characterization of these complications as well as their frequency is difficult. The high frequencies of developmental delays, severe seizures, head injuries, antiepileptic drug burden, and other factors limit the ability to attribute a specific change to surgical intervention, since surgery can change multiple factors. For example, subtle behavioral changes in executive function and personality are difficult to delineate in a population with preexisting neurologic and psychiatric disorders. Despite this, a clearer picture of the effects of callosotomy, as defined by clinical neurology and neuropsychology as well as cognitive neuroscience, is emerging.
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Affiliation(s)
- Orrin Devinsky
- Department of Neurology, NYU School of Medicine, New York, NY, USA.
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