title: Selective posterior callosotomy for drop attacks: A new approach sparing prefrontal connectivity.
abstract: OBJECTIVE
  To evaluate a novel approach to control epileptic drop attacks through a selective posterior callosotomy, sparing all prefrontal interconnectivity.
  
  
  METHODS
  Thirty-six patients with refractory drop attacks had selective posterior callosotomy and prospective follow-up for >4 years. Falls, episodes of aggressive behavior, and IQ were quantified. Autonomy in activities of daily living, axial tonus, and speech generated a functional score ranging from 0 to 13. Subjective effect on patient well-being and caregiver burden was also assessed.
  
  
  RESULTS
  Median monthly frequency of drop attacks decreased from 150 to 0.5. Thirty patients (83%) achieved either complete or >90% control of the falls. Need for constant supervision decreased from 90% to 36% of patients. All had estimated IQ below 85. Median functional score increased from 7 to 10 (p = 0.03). No patient had decrease in speech fluency or hemiparesis. Caregivers rated the effect of the procedure as excellent in 40% and as having greatly improved functioning in another 50%. Clinical, EEG, imaging, and cognitive variables did not correlate with outcome.
  
  
  CONCLUSIONS
  This cohort study with objective outcome assessment suggests that selective posterior callosotomy is safe and effective to control drop attacks, with functional and behavioral gains in patients with intellectual disability. Results are comparable to historical series of total callosotomy and suggest that anterior callosal fibers may be spared.
  
  
  METHODS
  This study provides Class III evidence that selective posterior callosotomy reduces falls in patients with epileptic drop attacks.
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Eliseu
authors.initials: E
authors.lastname: Paglioli
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: William Alves
authors.initials: WA
authors.lastname: Martins
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Ney
authors.initials: N
authors.lastname: Azambuja
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Mirna
authors.initials: M
authors.lastname: Portuguez
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Thomas More
authors.initials: TM
authors.lastname: Frigeri
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Larissa
authors.initials: L
authors.lastname: Pinos
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Saute
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Cora
authors.initials: C
authors.lastname: Salles
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: João Rubião
authors.initials: JR
authors.lastname: Hoefel
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Ricardo Bernardi
authors.initials: RB
authors.lastname: Soder
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Jaderson Costa
authors.initials: JC
authors.lastname: da Costa
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Marta
authors.initials: M
authors.lastname: Hemb
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Theys
authors.affiliation: From the Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas (E.P., W.A.M., N.A., M.P., T.M.F., J.C.d.C., M.H., A.P.), The Brain Institute (M.P., R.B.S., J.C.d.C.), and Faculty of Medicine (E.P., N.A., M.P., L.P., R.S., C.S., J.R.H., R.B.S., J.C.d.C., M.H., A.P.), Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; and Department of Neurosurgery (T.T.), Universitaire Ziekenhuizen Leuven, Belgium. andre.palmini@pucrs.br alpalmini@gmail.com.
authors.forename: André
authors.initials: A
authors.lastname: Palmini
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002648:Child; D003337:Corpus Callosum / Q000601:surgery*; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009434:Neural Pathways / Q000601:surgery; D017397:Prefrontal Cortex / Q000502:physiology*; D011612:Psychosurgery / Q000379:methods*; D012189:Retrospective Studies; D013575:Syncope / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult