Clinical profiles for seizure remission and developmental gains after total corpus callosotomy

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• 作者：Masaki Iwasaki^a ; ^{iwa@nsg.med.tohoku.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Mitsugu Uematsu^b ; Naomi Hino-Fukuyo^b ; Shin-ichiro Osawa^a ; Yoshiteru Shimoda^a ; Kazutaka Jin^c ; Nobukazu Nakasato^c ; Teiji Tominaga^c
• 关键词：Corpus callosotomy ; Seizure outcome ; Pediatric epilepsy ; Development ; Generalized epilepsy ; Infantile spasms
• 刊名：Brain and Development
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：38
• 期：1
• 页码：47-53
• 全文大小：254 K

文摘

This study was aimed to determine what preoperative profiles were associated with seizure remission after corpus callosotomy and whether such seizure outcome was associated with the postoperative developmental outcome.

Methods

This retrospective study included 26 consecutive patients with childhood onset epilepsy who underwent one-stage total corpus callosotomy at our institution and were followed up for a minimum of 1 year. The age at surgery ranged from 13 months to 32 years (median 6 years). The association between postoperative seizure freedom and preoperative profiles, post-operative developmental gains was examined.

Results

Five patients achieved seizure freedom (Engel class I), and 10 patients achieved worthwhile reduction of seizures (class III), whereas the remaining patients had a class IV outcome. All five seizure-free patients had “lack of abnormal magnetic resonance imaging findings”, “lack of proven etiology of seizures”, and underwent “surgery at age 6 years or younger”. These three factors were associated with seizure freedom (p < 0.05, Fisher exact test). Post-operative gains in developmental quotient were significantly better in patients with seizure freedom than in those without (p < 0.05, Mann Whitney U test).

Conclusion

Our study replicated the notion that seizure remission can be achieved after total corpus callosotomy in subsets of patients with medically-uncontrolled epilepsy, and suggested that a better developmental outcome can be expected in patients benefiting from seizure freedom.