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Epilepsy
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Donald C. Barr, Andres M. Kanner
It is a surgical option in patients with Lennox–Gastaut syndrome, aimed specifically at decreasing the frequency of drop attacks. The theory is that this procedure interrupts propagation of seizure activity between the hemispheres, thus preventing bilateral electrical synchrony and stopping unilateral seizures from generalizing. Corpus callosotomy has been shown to be most effective in patients (often children) with intractable atonic or tonic seizures which have resulted in falls (“drop attacks”) and injuries, and do not respond to treatment with medication or VNS.
Ketogenic Diets
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Douglas R. Nordli, Dorcas Koenigsberger, Joanne Schroeder, Darryl C. de Vivo
Relatively few patients that one would consider for the ketogenic diet would be candidates for focal resective surgery. Most do not have a discrete area or “pacemaker region” generating epileptiform activity. However, a recent report regarding outcome of focal resective surgery for patients with infantile spasms suggests this may be a consideration for selected patients (22). Corpus callosotomy also may be considered (see chapter 25). In general, however, most youngsters in whom there is a reasonable suspicion that the diet may be efficacious should have an adequate trial before moving to more invasive and irreversible therapies.
Therapeutic Gases for Neurological Disorders
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
R. Rachana, Tanya Gupta, Saumya Yadav, Manisha Singh
Corpus callosotomy is a neurosurgical procedure used to control nonfocal epilepsy, drop attacks, atonic seizures, tonic–clonic seizures, Lennox–Gastaut syndrome, and recurrent status epilepticus (Maehara and Shimizu, 2001; Oguni et al., 1991).
Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery
Published in International Journal of Hyperthermia, 2020
Madison Remick, Michael M. McDowell, Kanupriya Gupta, James Felker, Taylor J. Abel
LITT has also been proposed as an alternative approach for corpus callosotomy with initial studies showing efficacy similar to traditional open callosotomy [54]. LITT callosotomy can be complete, anterior two-thirds only, or complete callosotomy using additional laser trajectories (Figure 2). In a previous study investigating the effectiveness of LITT in completion callosotomy, two adult patients saw zero recurrence of targeted atonic seizures, while the remaining four (including two pediatric) saw substantial reduction in the frequency of their targeted atonic or generalized tonic clonic seizures [55]. Fractional anisotropy (FA) can be used as a measure to quantify the anisotropic diffusion in white matter fiber tracts, reflecting the directionality and structural organization of white matter and may be used in planning or post-ablation evaluation of LITT callosotomy. This study showed that in four of the patients that had pre and post-operative FA data, including two pediatric patients, FA in the corpus callosum decreased after surgery, suggesting that the LITT procedure was effective at disrupting the organization and structure of the callosal fiber tracts [55]. Similar to other emerging indications for LITT, further work is necessary to characterize the long-term outcomes of LITT callosotomy.
Treatment of infantile spasms: why do we know so little?
Published in Expert Review of Neurotherapeutics, 2020
Nicola Specchio, Nicola Pietrafusa, Alessandro Ferretti, Luca De Palma, Marta Elena Santarone, Chiara Pepi, Marina Trivisano, Federico Vigevano, Paolo Curatolo
Corpus callosotomy (CS) can also be considered in brain MR negative patients unsuitable for resective surgery [138]; however, experience is still limited. Vagal nerve stimulation (VNS) might be a potential option in patients with ES and tonic spasms (TS). A study investigating VNS enrolled both patients with ES and/or TS (16 patients) and patients with focal seizures with or without secondary generalization (16 patients). Results suggest that only 13% of patients with ES and/or TS had a seizure reduction greater than 50%. The authors concluded that VNS is less effective in the treatment of ES and tonic seizures than compared with patients with focal and focal to bilateral seizures [139]. The latter group of patients also included both patients with ES and patients with TS (or both); therefore, definitive conclusion on the effect of VNS on ES is not yet possible.
Avoiding complacency when treating uncontrolled seizures: why and how?
Published in Expert Review of Neurotherapeutics, 2020
Ushtar Amin, Selim R. Benbadis
When resective surgery is not a curative option, surgery can still be performed palliatively to help with seizure reduction and improve QoL in certain patients. Although there are no universally accepted indications for the intervention as of yet, corpus callosotomy is a palliative surgery that can be used in patients with refractory generalized or multifocal epilepsy who experience drop attacks [48]. The underlying thought behind the benefits of a corpus callosotomy is that the corpus callosum is the key pathway for the spread of seizures across the two hemispheres [47]. Typically, improvement in 65%-85% of patients is observed, specifically reduction in drop attacks [47]. Of the two types of surgery, anterior and total corpus callosotomy, total corpus callosotomy results in better seizure reduction; however, it carries a higher risk of transient disconnection syndromes [47]. Patients who are younger at the time of surgery, who have drop attacks with slow spike wave patterns on ictal and interictal EEG, and who develop reduced synchronicity of postoperative discharges are likely to have the best outcomes following corpus callosotomy [48].