Authors :
Presenting Author: Nassim Naderi, MD – Children`s Hospital of Orange County-UC Irvine
Shivani Baisiwala, MD – Resident, Neurosurgery, UCLA; Jeffery Sawrz, MD, MPH – Pediatric Epilepsy Fellow, Pediatric Neurology, UCLA; Sonia Wang, BS – Medical Student, Neurosurgery, UCLA; Atsuro Daida, MD, PhD – Research Fellow, Pediatric Neurology, UCLA; Rajsekar Rajaraman, MD, MS – Assistant Professor, Pediatric Neurology, UCLA; Shaun Hussain, MD, MS – Assistant Professor, Pediatric Neurology, UCLA; Aria Fallah, MD, MS – Associate Professor, Neurosurgery, UCLA; Hiroki Nariai, MD, PhD, MS – Assistant Professor, Pediatric Neurology, UCLA
Rationale:
Corpus callosotomy (CC) is often utilized as a palliative strategy for children suffering from refractory generalized seizures without identifiable focal lesions. Literature suggests that CC may mitigate epileptic spasms in Infantile Epileptic Spasms Syndrome (IESS) or reveal concealed focal epileptogenic zones. In Lennox-Gastaut Syndrome (LGS) patients, CC has demonstrated efficacy in reducing tonic or atonic seizure. This study aims to report our experience with CC.
Methods:
We identified patients with IESS and LGS who underwent CC from July 2018 to August 2022 at UCLA Mattel Children’s Hospital, who had at least 6 months of post-operative follow-up. This cohort underwent a pre-surgical evaluation, which included video EEG, brain MRI, and FDG-PET scan, and was deemed unsuitable for resective surgery.
Post-operative seizure outcomes were based on the six months follow-up. Demographics, etiology, operative details including perioperative complications, as well as pre- and post-operative seizure frequency were recorded.
Results:
A total of 21 patients (7 female) with refractory IESS (7 patients) and LGS (14 patients) underwent CC (3 anterior two-third, 18 complete). Median age at epilepsy onset and CC were three months (13 days-14 months) and 22 months (10 months-12 years) respectively.
The most common etiology was mixed genetic with structural abnormality. Seizure frequency range was from daily to >100 seizures per day. The median number of failed therapies prior to CC was eight, with the range between 4-14 anti-seizure medications. One patient also failed VNS prior to CC.
After CC, two patients (9.5%) became seizure-free. One patient (4.7%) had a >90% reduction in seizure frequency, 5 patients (23.8%) had a >=50% reduction, and 10 patients (47.6%) had a < 50% seizure reduction. Following CC, three patients (14.2%) had lateralization of spasms/seizures. Subsequent hemispherectomy or resective surgery in these cases led to seizure freedom six months after the combined procedures. Patients who became seizure-free were younger than 28 months.
The majority of CC was performed as an open surgery (19 microsurgery, two laser interstitial thermal therapy). Complication rate was 28.5% (6/21). Reported complications were two small size intracranial hemorrhage of no clinical significance, including one iatrogenic intracranial left pericallosal arterial injury requiring intra-operative repair and one small thalamic bleed noted on MRI post-op, one CSF leak, one with iatrogenic cardiac arrest due to oversedation, one aseptic meningitis and one with encephalopathy which required prolonged hospital stay. The median length of hospital stay was four days.
Conclusions:
Corpus callosotomy is an effective and safe procedure in this relatively young patient cohort with otherwise non-lateralizable/non-localizable cases with epileptic spasms and LGS.
Our findings suggest that CC should be considered early in the course for this population. Further larger clinical studies with a longer follow-up period will be needed to establish the clinical outcomes of this treatment.
Funding: N/A