Corpus Callosotomy for Intractable Epilepsy in Children: Seizure Outcome and Prognostic Factors

Kim, Kyung Min; Kim, Deok Soo; Ko, Tae Sung; Lee, Jung Kyo; Kim, Jeong Ho

Abstract

PURPOSE: The therapeutic effectiveness of callosotomy in controlling medically intractable epilepsy has been discussed since first case reported. Nevertheless, patient selection, type of seizures and epileptic syndromes are now better determined. We reviewed the outcome of corpus callosotomy in 20 pediatric patients and tried to identify factors associated with good outcome.
METHODS
The medical records of all pediatric patients who underwent corpus callosotomy at Asan medical center between 1996 and 2000 were retrospectively analyzed.
RESULTS
At the time of last follow-up, four patients(20%) became seizure free, fifteen patients(75%) had significant improvement in seizure control, and two patients(10%) remained unchanged. No significant association was found between seizure outcome and age at operation, or duration of seizure, intracranial pathology, or extent of callosal section. Drop attacks are most likely to be benefited by callosotomy in view of the frequency of seizure. This was followed by generalized tonic-clonic and myoclonic seizures. Complex partial seizures had the worst response.
CONCLUSIONS
Corpus callosotomy is valuable for controlling medically intractable generalized seizures in appropriate patients. Overall, drop attacks were one of the most frequent seizure pattern and they were also most likely to be benefited from corpus callosotomy. Though most patients do not become seizure-free after corpus callosotomy, worthwhile palliation of an otherwise intractable illness can be achieved. An analysis of prognostic factors should lead to better selection of patients for surgery.