Long-term seizure and behavioral outcomes after corpus callosotomy

Passamonti, Claudia; Zamponi, Nelia; Foschi, Nicoletta; Trignani, Roberto; Luzi, Michele; Cesaroni, Elisabetta; Provinciali, Leandro; Scerrati, Massimo

doi:10.1016/j.yebeh.2014.08.130

Cited by 31 publications

(15 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results support existing data showing that callosotomy can be performed safely with minimal risk of a new deficit. 36 The procedure brought seizure relief to 21 of 26 patients; either directly, by ameliorating atonic and/or tonic seizures, and/or generalized seizures with apneic-cyanotic spells, or indirectly, by enabling lateralization and resective treatment. 34 Our experience in some patients with nonlesional epilepsy that lateralized after callosotomy, but whose seizures recurred after resective procedures from another location, has prompted a shift toward the possible application of responsive neurostimulation (RNS) in similar future cases.…”

Section: Outcomes Of Palliative Proceduresmentioning

confidence: 99%

Epilepsy surgery in patients with autism

Kokoszka¹,

McGoldrick

Vega‐Talbott

et al. 2017

PED

View full text Add to dashboard Cite

OBJECTIVE The purpose of this study was to report outcomes of epilepsy surgery in 56 consecutive patients with autism spectrum disorder. METHODS Medical records of 56 consecutive patients with autism who underwent epilepsy surgery were reviewed with regard to clinical characteristics, surgical management, postoperative seizure control, and behavioral changes. RESULTS Of the 56 patients with autism, 39 were male, 45 were severely autistic, 27 had a history of clinically significant levels of aggression and other disruptive behaviors, and 30 were considered nonverbal at baseline. Etiology of the epilepsy was known in 32 cases, and included structural lesions, medical history, and developmental and genetic factors. Twenty-nine patients underwent resective treatments (in 8 cases combined with palliative procedures), 24 patients had only palliative treatments, and 3 patients had only subdural electroencephalography. Eighteen of the 56 patients had more than one operation. The mean age at surgery was 11 ± 6.5 years (range 1.5–35 years). At a mean follow-up of 47 ± 30 months (range 2–117 months), seizure outcomes included 20 Engel Class I, 12 Engel Class II, 18 Engel Class III, and 3 Engel Class IV cases. The age and follow-up times are stated as the mean ± SD. Three patients were able to discontinue all antiepileptic drugs (AEDs). Aggression and other aberrant behaviors observed in the clinical setting improved in 24 patients. According to caregivers, most patients also experienced some degree of improvement in daily social and cognitive function. Three patients had no functional or behavioral changes associated with seizure reduction, and 2 patients experienced worsening of seizures and behavioral symptoms. CONCLUSIONS Epilepsy surgery in patients with autism is feasible, with no indication that the comorbidity of autism should preclude a good outcome. Resective and palliative treatments brought seizure freedom or seizure reduction to the majority of patients, although one-third of the patients in this study required more than one procedure to achieve worthwhile improvement in the long term, and few patients were able to discontinue all AEDs. The number of palliative procedures performed, the need for multiple interventions, and continued use of AEDs highlight the complex etiology of epilepsy in patients with autism spectrum disorder. These considerations underscore the need for continued analysis, review, and reporting of surgical outcomes in patients with autism, which may aid in better identification and management of surgical candidates. The reduction in aberrant behaviors observed in this series suggests that some behaviors previously attributed to autism may be associated with intractable epilepsy, and further highlights the need for systematic evaluation of the relationship between the symptoms of autism and refractory seizures.

show abstract

Section: Outcomes Of Palliative Proceduresmentioning

confidence: 99%

Epilepsy surgery in patients with autism

Kokoszka¹,

McGoldrick

Vega‐Talbott

et al. 2017

PED

View full text Add to dashboard Cite

show abstract

“…In one large pediatric patient series, a complete arrest of drop attacks was reported in 67% of children after partial anterior callosotomy, and in 91% of those receiving complete callosotomy [113]. However, long-term results suggest that only 35% of callosotomy patients remain free of drop attacks five years after surgery, although the frequency of these seizures remains reduced in most patients [119,98]. Callosotomy utilization has decreased since the introduction of VNS, which also helps prevent tonic and atonic seizures, though there is disagreement regarding which intervention has the best efficacy/risk profile for this purpose [139,26,1,108,138].…”

Section: Disconnection Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

View full text Add to dashboard Cite

In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection.

show abstract

“…Although postsurgical cognitive complications such as disconnection syndrome have been reported more frequently in patients after CC, a recent paper found that after this procedure, half of patients showed attention enhancement (related to improvement in drop attacks) and behavioral outcome was better at earlier age of surgery. 49 Practice Points for Epilepsy Surgery and ID 1 Intellectual disability is not a contraindication for epilepsy surgery, and a presurgical evaluation should be offered in refractory cases as in other patients with epilepsy. 2 Epilepsy surgery can benefit cognitive and behavioral outcomes, especially in patients who remain seizure free.…”

Section: Practice Points For Pharmacological Treatments Of Behavioralmentioning

confidence: 99%

Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE

et al. 2016

View full text Add to dashboard Cite

SummaryThe management and needs of people with intellectual disability (ID) and epilepsy are well evidenced; less so, the comorbidity of behavioral disorder in this population. “Behavioral disorder” is defined as behaviors that are difficult or disruptive, including stereotypes, difficult or disruptive behavior, aggressive behavior toward other people, behaviors that lead to injury to self or others, and destruction of property. These have an important link to emotional disturbance. This report, produced by the Intellectual Disability Task Force of the Neuropsychiatric Commission of the ILAE, aims to provide a brief review of some key areas of concern regarding behavioral disorder among this population and proposes a range of research and clinical practice recommendations generated by task force members. The areas covered in this report were identified by experts in the field as being of specific relevance to the broad epilepsy community when considering behavioral disorder in persons with epilepsy and ID; they are not intended to be exhaustive. The practice recommendations are based on the authors’ review of the limited research in this field combined with their experience supporting this population. These points are not graded but can be seen as expert opinion guiding future research and clinical practice.

show abstract

Long-term seizure and behavioral outcomes after corpus callosotomy

Cited by 31 publications

References 28 publications

Epilepsy surgery in patients with autism

Epilepsy surgery in patients with autism

Seizure outcomes in nonresective epilepsy surgery: an update

Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE

Contact Info

Product

Resources

About