Anterior Corpus Callosotomy in Patients with Intractable Generalized Epilepsy and Mental Retardation

Abstract

Aims: To prospectively study outcomes of anterior corpus callosotomy (aCCT) in patients with refractory generalized epilepsy (RGE) and mental retardation (MR), and estimate the effect of preoperative Wechsler Full Scale Intelligence Quotient (FIQ) on surgical outcomes. Methods: Selected patients with RGE were divided into a moderate MR group (MoMR), mild MR group (MiMR) and no MR group (NMR), and all of them were treated with aCCT. Seizure outcomes were evaluated at the 1-year follow-up (1FU) and 2-year follow-up (2FU), and changes of quality of life (QOL) and IQ were tested at 2FU. Results: Seizure control did not differ by group or follow-up period. Most seizure reduction was achieved in atonic or tonic seizures with 76–80% reduction at 1FU and 81–87% at 2FU; myoclonic epilepsy was the least likely to respond. QOL changes differed among groups, and 53.2% of total patients showed postoperative QOL improvement: 75% in the MoMR group, 65% in the MiMR group and 21.1% in the NMR group. No significant group difference was seen in FIQ change, although average postoperative performance IQ (PIQ) improvement in patients with MR exceeded 4 points. Conclusion: aCCT can reduce seizures and is a safe surgical procedure. Low IQ does not affect seizure outcome and can be associated with a good surgical outcome in PIQ and QOL improvement.

Long-term seizure and behavioral outcomes after corpus callosotomy

“…Attention enhancement was seen in those patients who also experienced a consistent reduction in drop attacks (N 50%), confirming a close link between postsurgery clinical amelioration and attention improvement [7]. More importantly, the observed amelioration was independent of AED therapy changes, a finding also reported in different studies with a similar population [5][6][7]. The number of antiepileptic drugs was reduced postoperatively in five patients, all of them with complete control of drop seizures and amelioration of attention functions.…”

“…Some recent studies have reported preserved cognitive functions and improved attention in the short period after surgery, confirming previous evidence of limited adverse effects on cognition [4][5][6][7]. However, CC is sometimes responsible for the well-known "disconnection syndrome" and other adverse effects, such as language impairments and memory deficits.…”

“…It was observed that caregivers' satisfaction with surgery outcomes mainly correlates with seizure reduction but can be also influenced by behavioral changes [15,16]. However, studies assessing functional outcome typically have short follow-ups (maximum of 2 years), mainly focus on the pediatric population only, and usually report a global evaluation of behavioral changes [5][6][7]. Moreover, predictors of outcomes are still unclear.…”

Seizure Control of Current Shunt on Rats with Temporal Lobe Epilepsy and Neocortical Epilepsy

“…The current mechanisms of anti-epilepsy therapies primarily focus on three aspects [5], [25]–[27]: (1) resecting the epileptogenic zone through resective surgery, stereotactic radiofrequency ablation, and stereotactic radiotherapy; (2) blocking the propagation pathway, such as the corpus callosotomy, and multiple subpial transaction; and (3) decreasing cortex excitability, using drugs, neuromodulation therapy and so on. Thus, the basic idea of all traditional therapies is “inhibition”.…”

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

“…3,6,11 Therefore, the use of CC is restricted mainly to patients with intractable seizure. 6 To spare neurological functions, some authors advocate anterior or partial CC, leaving the splenium, [12][13][14] whereas, others consider complete or total CC to be more effective, especially in children. [14][15][16][17] The present study performs a systematic review with meta-analysis of the literature that involves direct comparisons of seizure outcome among pediatric patients after anterior or complete CC.…”