[A case of intractable epilepsy presenting epileptic spasm treated with callosotomy in childhood].
We present a case of intractable epilepsy presenting epileptic spasm successfully treated with anterior callosotomy in childhood. A 12-year-old boy had seizures frequently since the age of 11 months which were diagnosed as an infantile spasm. He underwent various treatments including ACTH therapy, but the seizures were intractable. Characteristics of his seizures were an abrupt axial movement leading to sustained posturing, most often truncal, and neck flexion with pronounced arm extension and abduction. He lost consciousness transiently and these seizures frequently occurred in clusters and the duration of seizure was 1 to 3 seconds. Neurologically he had no deficit, but his intelligence was below the standard level. Magnetic resonance image (MRI) showed no abnormalities in the brain. Electroencephalogram (EEG) demonstrated secondary bilateral synchrony (SBS) with left frontal dominance in amplitude. Subdural strip electrodes were implanted bilaterally over the frontal lobes to detect an epileptogenic region. However intracranial ictal-EEG demonstrated an abrupt bilateral desynchronization for 1-3 seconds. As the epileptogenic zone was not clearly identified and an abrupt bilateral desynchronization was identified, anterior callosotomy was performed. Since surgery, he has remained seizure-free for two years while taking anticonvulsants and the SBS has disappeared. This case may indicate that the corpus callosum influences the occurrence of epileptic spasm and SBS on EEG.
Tanaka
Nobuhiro
N
Department of Neurosurgery, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube-city, Yamaguchi 755-8505, Japan.
Fujii
Masami
M
Akimura
Tatsuo
T
Harada
Katsumi
K
Kajiwara
Kouji
K
Kato
Shouichi
S
Nomura
Sadahiro
S
Ishihara
Hideyuki
H
Suzuki
Michiyasu
M
D002648:Child; D003337:Corpus Callosum / Q000503:physiopathology / Q000601:surgery*; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D013035:Spasm / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome