Callosotomy for drop attacks and epileptic spasms

Abstract

Corpus callosotomy is a palliative operation used for almost 80 years for patients with intractable bilateral seizures, when a resective procedure is not possible. Newer, minimally invasive approaches, such as MRI-guided laser-induced thermocoagulation are presumably comparable in results and complication rates but more data are needed. In many case series, callosotomy was effective especially in reducing drop attacks and in some series also in reducing epileptic spasms. General cessation of seizures is exceedingly rare. Surgical complications, such as bleeding or infections occur in about 5%. The main side effect of callosotomy is a disconnection syndrome with apraxia, tactile and visual anomia, neglect or supplementary motor area (SMA) syndrome. Disconnection syndrome is transient in most cases, especially in children. Whether an anterior or a complete callosotomy is performed varies from center to center. Complete callosotomy is more efficient but accompanied by a higher risk for complications and side effects. One option is a two-step callosotomy with an anterior disconnection first and completion in those cases without clear benefits in a second step.