Extended, one-stage callosal section for treatment of refractory secondarily generalized epilepsy in patients with Lennox-Gastaut and Lennox-like syndromes.
OBJECTIVE
We report on the efficacy and safety of extended one-stage callosal section performed in a large and homogeneous series of patients.


METHODS
Seventy-six patients with Lennox-Gastaut (n = 28) and Lennox-like (n = 48) syndrome were studied (42 male patients; mean age, 11.2 years). All patients had multiple seizure types per day, including atonic, tonic-clonic, atypical absence, myoclonic, and tonic seizures. All of them were developmentally impaired. The EEG showed intense secondary bilateral synchrony in all of them. All patients were submitted to an extended, one-stage, callosal section, leaving only the splenium intact. Mean follow-up time was 4.7 years.


RESULTS
Worthwhile improvement (>50%) was noted in 69 of 76 patients; 52 patients had a > or =90% reduction in seizure frequency. Seven patients were seizure free after surgery. The seizure patterns most responsive to surgery were atonic (92%), atypical absence (82%), and tonic-clonic (57%) seizures. All patients had some degree of a transient acute postoperative disconnection syndrome. A consistent increase in attention level was observed postoperatively.


CONCLUSIONS
We report one of the larger homogeneous series of patients submitted to callosotomy and are the first to report on the effectiveness and safety of performing extended callosal section in a single stage in this patient group. Extended callosal section should be considered a good palliative surgical option for suitable candidates. The increase in attention level was as useful as seizure control in improving quality of life of these patients.
Cukiert
Arthur
A
Department of Neurology and Neurosurgery, Hospital Brigadeiro and São Paulo Epilepsy Clinic, R Dr. Alceu Campos Rodrigues 247, #121 São Paulo SP, Brazil CEP 04544-000. acukiert@uol.com.br
Burattini
Jose Augusto
JA
Mariani
Pedro Paulo
PP
Câmara
Ródio Brandão
RB
Seda
Lauro
L
Baldauf
Cristine Mella
CM
Argentoni
Meire
M
Baise-Zung
Carla
C
Forster
Cássio Roberto
CR
Mello
Valeria Antakli
VA
D001288:Attention / Q000502:physiology; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D003337:Corpus Callosum / Q000601:surgery*; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D004829:Epilepsy, Generalized / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D016896:Treatment Outcome