Abstracts

Rationale: Total corpus callosotomy (TCC) is a palliative surgical procedure that is suitable for patients with refractory seizures who are not candidates for focal resective surgery. In addition to seizure reduction, some pediatric patients also present improved development and behavior after TCC. However, there is little data available regarding the effect of TCC on the development in children with intractable epilepsy.Methods: This study included 14 patients who underwent TCC until 5 years old from April 2007 to March 2015 for alleviation of intractable epilepsy with minimum 18 months post-operative follow up. Mean age at epilepsy onset was 7 months, mean age at surgery was 13 months, mean duration of epilepsy was 20 months, and mean follow-up time was 25 months. Etiologies were identified in 4 patients, including tuberous sclerosis, schizencephaly, encephalitis, and genetic mutation (FTSJ1) in one each. Seizure outcomes were classified by Engel classification. Pre- and postoperative developmental outcomes were also measured as developmental age (DA), developmental quotient (DQ) and developing rate (DR = gain of DA / follow-up period), by using the Kinder Infant Development Scale, which is a Japanese parent-reported rating scale that consists of a list of behaviors in the following 6 subscales: gross motor, fine motor, comprehension, speech, social skill and feeding.Results: Seizure free (Engel class I) was achieved in 4 patients (29%) and Engel class II, III, and IV were observed in 2, 3, and 5 patients, respectively. Although postoperative DQ declined in 11 patients, DA increased in 10 patients, that is, 70% of patients got modest postoperative improvement. Higher preoperative DQ was significantly correlated with higher postoperative DQ (p=0.0015), and DR was higher in patients with good seizure outcome (Class I + II) compared to those with poor seizure outcome (III +IV) (p=0.05). In terms of subscales, DR of fine motor and feeding were higher in patients with good seizure outcome (p=0.02, and p=0.05, respectively).Conclusions: Our results suggest that TCC for the children with intractable epilepsy may facilitate additional developmental improvement. Preoperative DQ and seizure outcome are important factor of developmental outcome. In particular, fine motor skill and feeding skill developed significantly in patients with good seizure outcome.