Neuropediatrics 2011; 42 - P103
DOI: 10.1055/s-0031-1274075

Corpus callosotomy for children suffering from intractable focal epilepsy presenting a non-laterialized EEG and unilateral lesion

T Getzinger 1, T Pieper 1, S Keßler-Uberti 2, B Pascher 2, H Eitel 2, T Hartlieb 2, I Blümcke 3, PA Winkler 4, M Kudernatsch 4, O Delalande 5, M Staudt 1, H Holthausen 1
  • 1Schoen Klinik Vogtareuth, Neuropädiatrie, Vogtareuth, Germany
  • 2Schoen Klinik Vogtareuth, Vogtareuth, Germany
  • 3Universität Erlangen, Neuropathologisches Institut, Erlangen, Germany
  • 4Schoen Klinik Vogtareuth, Neurochirurgie, Vogtareuth, Germany
  • 5Fondation Rothschild Hospital Paris, Pädiatrische Neurochirurgie, Paris, France

Objective: It is known that epilepsy surgery is a successful treatment even for children in their 1st year of life who suffer from intractable focal epilepsy. Age dependent bilateral or even generalized EEG-findings and semiology may complicate the electro-clinical-anatomical correlation. Due to frequent seizures with encephalopathic course surgery is considered early on; therefore, rapid lateralization and localization of the epileptogenic zone is necessary.

In 5 children with either suspected or actual unilateral epileptogenic lesion and non-lateralized interictal and ictal epileptiform discharges we performed a corpus callosotomy (CC) to lateralize the epilepsy.

Methods: Out of 311patients who underwent epilepsy surgery between 09/1998 and 11/2010at the Epilepsy Center for Children and Adolescents, Schoen Klinik Vogtareuth, retrospective data of 5 patients in which CC was performed are presented. All patients underwent video-EEG long-term monitoring at least once plus high resolution MRI. Presurgical intensive diagnostic work up ruled out etiologies other than focal epilepsy caused by a lesion.

Results: 5 patients had CC (f:1; m:4). All were severely retarded mentally. Etiology: Malformation of cortical development in 3, polymicrogyria in 2 patients. Average age at onset of epilepsy: 0,37 y, at surgery: 1,8 y, postoperative follow up: 12 months.

Lateralization and localization of the epilepsy was possible In 2 patients after CC: One of the two underwent temporo-parieto-occipital resection, the other underwent hemispherotomy.

Seizure outcome: After CC: Seizure-free: None; after the 2nd surgery: Seizure-free: 1, >50% seizure reduction: 1

Conclusion: CC was helpful in 2 patients to lateralize the epilepsy in accordance with the side of the lesion and in order to find a decision regarding 2nd surgery, which then led to an improvement of epilepsy.

In 2 of the remaining 3 patients seizure frequency was reduced and interaction improved.

CC can be helpful in the diagnostic work-up of infantile unilateral lesional epilepsy.