Corpus callosotomy outcomes in pediatric patients: A systematic review

Abstract

SUMMARYObjective: Corpus callosotomy is a palliative neurosurgical treatment for patients with either generalized or multifocal refractory epilepsy and injurious drop attacks. This report aims to systematically review the pediatric literature. Methods: Medline, Embase, Web of Knowledge, and Scopus were searched systematically for published articles on treatment outcomes of corpus callosotomy for refractory epilepsy. Studies were included if the patient population was younger than 18 at the time of surgery and median follow-up was >1 year. Studies were excluded if resective surgery was also performed. Results: A total of 12 articles met inclusion criteria. All articles were retrospective case series, with the exception of one being a prospectively designed retrospective case series. There was very little agreement among authors on the definition of a good seizure outcome. Articles that used the Engel classification found that 88.2% of total corpus callosotomy patients had a worthwhile reduction in seizures compared with 58.6% of patients who underwent anterior corpus callosotomy (p < 0.05). Drop attacks improved from corpus callosotomy more than other generalized seizure types. Reported complications were minor in all but one patient, and one death was reported. Transient disconnection syndrome was significantly more likely in total corpus callosotomy than in anterior corpus callosotomy (12.5% vs. 0%; p < 0.05). Improvements in quality of life, behavior, and intelligence/development quotient, as well as parental satisfaction, were generally correlated with seizure outcome. There was no postcallosotomy change in the number of antiepileptic drugs. Significance: Total corpus callosotomy was significantly more likely to result in a reduction in seizures. Anterior corpus callosotomy was unlikely to result in disconnection syndrome. Although all of the papers drew a similar conclusion, the quality of evidence was low. At best, the evidence raises the hypothesis that corpus callosotomy is a safe and effective treatment for refractory generalized epilepsy. It is clear that a casecontrol or randomized trial is warranted.

Seizure outcome after corpus callosotomy in a large paediatric series

“…Other long-term studies have shown sustained benefit. 1 The prospective, population-based study by Bjellvi et al perhaps provides the best evidence of complications after epilepsy surgery and they used a similar classification system to ours. Interest is also turning towards selective posterior corpus callosotomy, with the recent study by Paglioli et al finding 30 out of 36 patients were either free or almost free of drop attacks at last follow-up.…”

“…1 This may reflect a strategy for optimizing AED usage in order to reduce the number of side effects. 1 This may reflect a strategy for optimizing AED usage in order to reduce the number of side effects.…”

“…1 This is the first study of corpus callosotomy to investigate the temporal aspect of outcome for drop attacks. 1 This is the first study of corpus callosotomy to investigate the temporal aspect of outcome for drop attacks.…”

“…As discussed elsewhere in the literature, 1,18 there is a clear need for a randomized control trial of corpus callosotomy outcomes compared with optimal medical management. The design of such a trial was outlined by Graham et al in their systematic review based on the landmark randomized controlled trial of Wiebe et al of temporal lobectomy.…”

“…There are no universally accepted indications for corpus callosotomy, and patient selection is centre-and surgeon-dependent. 1 However, unlike adults, disconnection syndrome in children appears to always resolve within 3 months. 1 T ellez-Zenteno et al found that in studies without prolonged follow-up, 2 at least 65% of patients were likely to be either free or almost free of drop attacks but that sustained freedom from drop attacks diminished significantly beyond 5 years.…”