The Evolution of Corpus Callosotomy for Epilepsy Management

Vaddiparti, Aparna; Huang, Richard S.P.; Blihar, David; Plessis, Maira du; Montalbano, Michael J.; Tubbs, R. Shane; Loukas, Marios

doi:10.1016/j.wneu.2020.08.178

Cited by 28 publications

(20 citation statements)

References 46 publications

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“…Those studies, however, did not aim to inhibit seizures, and had bisected caudal CC mainly. In human CCT, neuro-endoscopic CCT and radiosurgical or laser interstitial thermal therapeutic CCT have been recently developed to decrease the invasiveness and the complication rates ( 2 , 3 , 9 ). If those types of equipment would be available in veterinary medicine, the surgical technique of CCT may change in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Corpus callosotomy (CCT), i.e., dividing hemispheres (split-brain) by disconnecting CC, is a type of palliative epilepsy surgery mainly applied to human patients with infantile epileptic encephalopathy and drug-resistant generalized epilepsy with atonic, absence, myoclonic, and tonic-clonic seizures (GTCS). In particular, the efficacy of CCT has been established in atonic or astatic seizures, also known as drop attack, that shows sudden astasia causing head injury ( 1 – 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…In particular, the efficacy of CCT has been established in atonic or astatic seizures, also known as drop attack, that shows sudden astasia causing head injury (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Corpus Callosotomy in a Cat With Drug-Resistant Epilepsy of Unknown Cause

et al. 2021

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A 2-month-old, intact male domestic shorthair cat with dullness, bilateral central blindness, and recurrent epileptic seizures was presented to a local clinic. Seizures were the generalized myoclonic and tonic-clonic type. Phenobarbital was initiated and maintained; however, seizures were not controlled. Other anti-seizure drugs, including levetiracetam, zonisamide, and diazepam, also provided insufficient seizure control with seizures occurring hourly to daily. By 8 months of age, the cat displayed non-ambulatory tetraparesis and deep somnolence. Magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and pre- and post-prandial total bile acid analyses were unremarkable. Scalp electroencephalography (EEG) revealed central dominant but generally synchronized spikes and multiple spikes. The cat was diagnosed with drug-resistant epilepsy of unknown cause and was included in a clinical trial of epilepsy surgery. Given the unremarkable MRI and bilateral synchronized EEG abnormalities, a corpus callosotomy was performed at 12 months of age, and partial desynchronization of spikes was confirmed on EEG. Incomplete transection was found in the genu of the corpus callosum on postoperative MRI. After surgery, the mental status and ambulation clearly improved, and seizure frequency and duration were remarkably reduced. Recheck with follow-up EEG and MRI were performed at 3, 6, and 12 months after surgery. Scores of activities of daily living and visual analog scales including cat's and owner's quality of life had also improved considerably. This case report is the first documentation of the one-year clinical outcome of corpus callosotomy in a clinical feline case with drug-resistant epilepsy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Report: Corpus Callosotomy in a Cat With Drug-Resistant Epilepsy of Unknown Cause

et al. 2021

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“…In the mid-twentieth century, this procedure received little attention. In 1962, Bogen and Vogel reported a patient who had undergone a total (complete) CC, who experienced intractable seizures due to a head injury sustained during World War II, and CC became a surgical treatment option for intractable seizures [ 21 , 22 ].…”

Section: History Of Corpus Callosotomy Types Of Disconnections and Complicationsmentioning

confidence: 99%

“…Fiber tract studies using magnetic resonance imaging (MRI) have shown that the posterior corpus callosum transfers perceptual information [ 24 ]. An anterior 1/2 to 4/5 CC technique has been selected for patients with intractable epilepsy to reduce disconnection syndromes [ 22 , 24 , 25 ]. For patients who demonstrate meaningful language, the anterior CC technique has been proposed as a first surgical treatment option [ 25 ].…”

Section: History Of Corpus Callosotomy Types Of Disconnections and Complicationsmentioning

confidence: 99%

Corpus Callosotomy for Controlling Epileptic Spasms: A Proposal for Surgical Selection

Okanishi

Fujimoto

2021

Brain Sciences

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In 1940, van Wagenen and Herren first proposed the corpus callosotomy (CC) as a surgical procedure for epilepsy. CC has been mainly used to treat drop attacks, which are classified as generalized tonic or atonic seizures. Epileptic spasms (ESs) are a type of epileptic seizure characterized as brief muscle contractions with ictal polyphasic slow waves on an electroencephalogram and a main feature of West syndrome. Resection surgeries, including frontal/posterior disconnections and hemispherotomy, have been established for the treatment of medically intractable ES in patients with unilaterally localized epileptogenic regions. However, CC has also been adopted for ES treatment, with studies involving CC to treat ES having increased since 2010. In those studies, patients without lesions observed on magnetic resonance imaging or equally bilateral lesions predominated, in contrast to studies on resection surgeries. Here, we present a review of relevant literature concerning CC and relevant adaptations. We discuss history and adaptations of CC, and patient selection for epilepsy surgeries due to medically intractable ES, and compared resection surgeries with CC. We propose a surgical selection flow involving resection surgery or CC as first-line treatment for patients with ES who have been assessed as suitable candidates for surgery.

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