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Published on: August 16, 2024
Corpus callosotomy outcomes in pediatric patients: A systematic review
David Graham1,2, Martin M Tisdall3, Deepak Gill1,2
1Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
Insights
Corpus callosotomy effectively reduces seizures in pediatric epilepsy, particularly drop attacks. While generally safe, total callosotomy carries a higher risk of disconnection syndrome, necessitating further research.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Epileptology
Background:
- Refractory epilepsy in children, especially with injurious drop attacks, presents significant treatment challenges.
- Corpus callosotomy serves as a palliative neurosurgical option for severe, generalized, or multifocal epilepsy.
- Systematic review of pediatric literature is crucial to evaluate corpus callosotomy outcomes.
Purpose of the Study:
- To systematically review the pediatric literature on the treatment outcomes of corpus callosotomy for refractory epilepsy.
- To assess the efficacy and safety of corpus callosotomy in patients under 18 years old.
- To analyze seizure reduction, complications, and quality of life improvements following the procedure.
Main Methods:
- Systematic search of Medline, Embase, Web of Knowledge, and Scopus databases.
- Inclusion criteria: patients <18 years at surgery, median follow-up >1 year, no concurrent resective surgery.
- Data extraction focused on seizure outcomes, complications, and quality of life indicators.
Main Results:
- 12 retrospective studies met inclusion criteria; one was a prospectively designed retrospective case series.
- Total corpus callosotomy showed significantly higher seizure reduction (88.2% Engel classification) than anterior callosotomy (58.6%).
- Drop attacks improved more than other generalized seizure types; transient disconnection syndrome was more frequent with total callosotomy (12.5% vs. 0%).
Conclusions:
- Total corpus callosotomy appears more effective for seizure reduction but increases the risk of disconnection syndrome compared to anterior callosotomy.
- Improvements in quality of life, behavior, and parental satisfaction generally correlated with seizure outcomes.
- The current evidence quality is low, highlighting the need for high-quality prospective studies, such as randomized controlled trials, to confirm efficacy and safety.
Objective:
Corpus callosotomy is a palliative neurosurgical treatment for patients with either generalized or multifocal refractory epilepsy and injurious drop attacks. This report aims to systematically review the pediatric literature.
Methods:
Medline, Embase, Web of Knowledge, and Scopus were searched systematically for published articles on treatment outcomes of corpus callosotomy for refractory epilepsy. Studies were included if the patient population was younger than 18 at the time of surgery and median follow-up was >1 year. Studies were excluded if resective surgery was also performed.
Results:
A total of 12 articles met inclusion criteria. All articles were retrospective case series, with the exception of one being a prospectively designed retrospective case series. There was very little agreement among authors on the definition of a good seizure outcome. Articles that used the Engel classification found that 88.2% of total corpus callosotomy patients had a worthwhile reduction in seizures compared with 58.6% of patients who underwent anterior corpus callosotomy (p < 0.05). Drop attacks improved from corpus callosotomy more than other generalized seizure types. Reported complications were minor in all but one patient, and one death was reported. Transient disconnection syndrome was significantly more likely in total corpus callosotomy than in anterior corpus callosotomy (12.5% vs. 0%; p < 0.05). Improvements in quality of life, behavior, and intelligence/development quotient, as well as parental satisfaction, were generally correlated with seizure outcome. There was no postcallosotomy change in the number of antiepileptic drugs.
Significance:
Total corpus callosotomy was significantly more likely to result in a reduction in seizures. Anterior corpus callosotomy was unlikely to result in disconnection syndrome. Although all of the papers drew a similar conclusion, the quality of evidence was low. At best, the evidence raises the hypothesis that corpus callosotomy is a safe and effective treatment for refractory generalized epilepsy. It is clear that a case-control or randomized trial is warranted.
