title: Outcome after extended callosal section in patients with primary idiopathic generalized epilepsy.
abstract: OBJECTIVE
  We report the outcome of patients with refractory idiopathic generalized epilepsy (IGE) who were submitted to extended one-stage callosal section.
  
  
  METHODS
  Eleven patients with IGE who were submitted to extended one-stage callosal section were studied. Preoperative workup included history and neurologic examination, interictal, and ictal electroencephalography (EEG) recording, high resolution 1.5T magnetic resonance imaging (MRI) and intelligence quotient (IQ) testing. All patients were submitted to extended one-stage microsurgical callosal section, leaving only the splenium intact.
  
  
  RESULTS
  Preoperative ictal patterns included repetitive spike and wave or polyspike and wave discharges or fast epileptic recruiting rhythm. MRI showed no focal lesions. Preoperatively, mean general IQ was 85. Postoperatively, at least a 75% reduction in the frequency of generalized tonic-clonic seizures was noted in all patients. In three patients absences disappeared completely, and the others had at least 90% reduction in seizure frequency. Only one patient had myoclonic seizures preoperatively, and these seizures disappeared after callosal section. After surgery, mean general IQ was 89. A very clear increase in attention level was noted in all patients. Postoperative interictal EEG recordings showed rupture of bilateral synchrony in all patients.
  
  
  CONCLUSIONS
  This article reports on a large and homogeneous series of patients with refractory IGE submitted for callosal section. There was a marked decrease in generalized seizure frequency and increase in the attention level in this patient population. Our results suggest that corticocortical interaction might have a role in IGE pathogenesis. Callosotomy is a safe, effective, and underused palliative procedure in these well-selected patients with refractory IGE.
authors.affiliation: Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, Brazil. acukiert@uol.com.br
authors.forename: Arthur
authors.initials: A
authors.lastname: Cukiert
authors.forename: Jose Augusto
authors.initials: JA
authors.lastname: Burattini
authors.forename: Pedro Paulo
authors.initials: PP
authors.lastname: Mariani
authors.forename: Cristine Mella
authors.initials: CM
authors.lastname: Cukiert
authors.forename: Meire
authors.initials: M
authors.lastname: Argentoni-Baldochi
authors.forename: Carla
authors.initials: C
authors.lastname: Baise-Zung
authors.forename: Cássio Roberto
authors.initials: CR
authors.lastname: Forster
authors.forename: Valeria Antakli
authors.initials: VA
authors.lastname: Mello
mesh_terms: D000328:Adult; D003337:Corpus Callosum / Q000601:surgery*; D004569:Electroencephalography / Q000379:methods; D004829:Epilepsy, Generalized / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult