Corpus Callosotomy for Atonic Drop Seizures in Bilateral Malformations of Cortical Development: A Systematic Review...

Malformations of cortical development (MCD) frequently manifest with epilepsy, often refractory to medical treatment. Atonic seizures, prevalent in MCD, pose significant challenges. Surgical interventions like corpus callosotomy are considered when medical control fails. However, debate persists over optimal techniques, particularly in bilateral MCD (BMCD). A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines analyzed studies on corpus callosotomy for atonic seizures in BMCD. Eligible studies encompassed patients undergoing anterior or total callosotomy post-failed medical therapy. Data extraction and quality assessment were performed independently by two reviewers. Nineteen primary articles involving 187 patients were included, analyzing outcomes of total callosotomy (TC) versus partial callosotomy (PC) in various BMCD types. TC demonstrated favorable seizure cessation rates, with notable improvements in tuberous sclerosis and cortical dysplasia cases. PC showed efficacy, especially in subcortical band heterotopia. Studies highlighted the need for long-term follow-up to assess sustained efficacy and neurocognitive impacts. This review underscores the potential of total callosotomy in severe refractory epilepsy associated with BMCD while acknowledging the utility of partial callosotomy in selected cases. Individualized approaches guided by pathology and seizure phenotype are crucial. Future research should focus on optimizing surgical techniques and exploring adjunctive therapies. Corpus callosotomy offers promise in managing atonic seizures in BMCD. Tailored surgical strategies, guided by comprehensive patient assessment, are essential. Continued research is imperative to refine techniques and enhance outcomes for this challenging patient population.