[A case of intractable epilepsy presenting epileptic spasm treated with callosotomy in childhood]

Area of Science:

• Pediatric Neurology
• Epileptology
• Neurosurgery

Background:

• Infantile spasms (IS) are a severe epilepsy syndrome in infants, often presenting as epileptic spasms.
• Intractable IS poses significant treatment challenges, necessitating exploration of novel therapeutic strategies.
• Secondary bilateral synchrony (SBS) on EEG is a recognized pattern in some epilepsy types.

Observation:

• A 12-year-old boy with a history of infantile spasms since 11 months old presented with intractable seizures.
• Despite various treatments, including ACTH therapy, seizures persisted, characterized by brief axial movements and posturing.
• EEG revealed secondary bilateral synchrony (SBS) with left frontal dominance, while intracranial EEG showed abrupt bilateral desynchronization during seizures.

Findings:

• Anterior callosotomy, a surgical procedure involving partial or complete sectioning of the corpus callosum, was performed due to the unclear epileptogenic zone and bilateral EEG findings.
• The patient remained seizure-free for two years post-surgery and the SBS pattern resolved.
• This outcome suggests a potential role of the corpus callosum in the generation or propagation of epileptic spasms and SBS.

Implications:

• Anterior callosotomy can be an effective treatment option for select cases of intractable infantile spasms.
• The findings highlight the corpus callosum's involvement in the pathophysiology of certain epileptic syndromes.
• Further research is warranted to elucidate the precise mechanisms by which the corpus callosum influences epileptic spasms and EEG patterns.