Changing the paradigm of 1-stage total callosotomy for the treatment of pediatric generalized epilepsy.
OBJECTIVE
The authors propose that anterior callosotomy -- thought to have some advantages over total callosotomy -- is not superior to total callosotomy for prevention of seizure propagation or other complications.


METHODS
The study comprised 34 patients in whom generalized epilepsy syndrome or frontal lobe seizures with a secondary generalization were diagnosed. Preoperatively, all patients suffered from disabling drop attacks or intense head-drop seizures, and some patients also experienced other types of seizures. The male/female ratio was 22:12, and patients ranged in age between 1 to 19 years (mean 8.7 years). The follow-up period ranged from 1.08 to 5.0 years (mean 2.58 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with the outcome was assessed postoperatively.


RESULTS
After undergoing 1-stage total callosotomy, drop attacks disappeared completely in 25 patients during the follow-up period, and in 6 patients the frequency of drop attacks decreased to < 10% of baseline. With regard to other types of seizures, seizures resolved completely in 12 patients, and in another 18 seizure frequency decreased. Two patients experienced a transient disconnection syndrome for 2 and 4 weeks. One patient experienced ataxic hemiparesis for 3 weeks before it completely abated. The overall daily function of the patients improved, and all parents were satisfied with the surgical outcome.


CONCLUSIONS
For pediatric generalized epilepsy syndrome, 1-stage total callosotomy will be the first choice in treatment for controlling generalized seizures.
Shim
Kyu-Won
KW
Department of Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-Gu, Seoul, Korea.
Lee
Young-Mok
YM
Kim
Heung-Dong
HD
Lee
Jun-Soo
JS
Choi
Joong-Uhn
JU
Kim
Dong-Seok
DS
D000203:Activities of Daily Living; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000601:surgery*; D004562:Electrocardiography; D004829:Epilepsy, Generalized / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D017060:Patient Satisfaction; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome