Corpus Callosotomy or Focal Surgery in Children Presenting With Generalized Tonic Seizures: Findings From the...

To elucidate the clinical profiles and surgical outcomes of patients with generalized tonic seizures (GTSs) undergoing corpus callosotomy (CC) or focal surgery (FS).

Subjects with GTS undergoing CC or FS were identified using the Pediatric Epilepsy Research Consortium surgery database. Between-group comparisons were performed to assess differences in presurgical epilepsy characteristics and postsurgical seizure outcomes.

Fifty-four patients (CC: 40 and FS: 14) included. Patients in the CC group had seizure onset at an older age (median = 1 year vs 0.4 years; P = 0.022), and were older at referral for phase-1 evaluation (median = 11.2 years vs 4.85 years; P = 0.026), and at time of surgery (median = 14 years vs 5.6 years; P = 0.008). The CC group showed higher rates of developmental delay (90% vs 57%; P = 0.013) and greater number of antiseizure medications attempted before surgery (median = 6 vs 4; P = 0.049). Electroencephalography localization also differed (P = 0.002), being most commonly generalized (64%, CC group) and multifocal (45%, FS group). Structural magnetic resonance imaging abnormalities were more common in FS group (92% vs 48%, P = 0.008). Median follow-up duration was 13.2 months (interquartile range = 5-24) in the CC group and 13.5 months in the FS group (interquartile range = 8-18). At last follow-up, FS group had a higher rate of seizure freedom (80% vs 19%; P = 0.0006).

Our findings demonstrate differences in baseline characteristics and postsurgical outcomes of patients with GTS referred for FS and CC. FS yielded high seizure-freedom rates in focal cases. For patients with no discernible seizure focus, CC was often delayed, though outcomes were generally favorable and delays likely unwarranted.