Abstract
Abstract *Masami Fujii, *Tatsuo Akimura, *Sadahiro Nomura, *Katsumi Harada, *Shoichi Kato, and *Michiyasu Suzuki *Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan . Purpose: We report a case of a child with intractable epilepsy with epileptic spasm, who was successfully treated with anterior callosotomy. Case Report: A 12-year-old boy had frequent seizures since age 11 months and was diagnosed as having infantile spasms. He underwent various treatments including adrenocorticotropic hormone (ACTH) therapy, but the seizures were intractable. Seizure characteristics included an abrupt axial movement (most often truncal) leading to sustained posturing and neck flexion with pronounced arm extension and abduction. He lost consciousness transiently during seizures. These seizures occurred frequently in clusters with seizure durations from 1 to 3 s. He was neurologically normal, but his intelligence was below the standard level. Conclusions: Magnetic resonance image (MRI) revealed no brain abnormality. Interictal electroencephalogram (EEG) demonstrated secondary bilateral synchrony (SBS) with left frontocentral dominance in amplitude. Nine subdural strip-electrodes were implanted bilaterally over the medial and lateral surfaces of the frontal lobes to detect an epileptogenic region. Intracranial ictal-EEG demonstrated an abrupt attenuation of background activities recorded simultaneously from bilateral frontal cortices, for 1–3 s during seizures. Because an abrupt bilateral frontal lobe desynchronization identified no epileptogenic focus, anterior callosotomy was performed. After surgery, he has remained seizure free for 18 months while still taking anticonvulsants. Postoperative EEGs demonstrated disappearance of the SBS pattern. Epileptiform discharges also were dramatically decreased and were localized only in the left frontal region (Fp1-F3). This case indicates that the corpus callosum may mediate epileptic spasm in cases showing EEG characterized by SBS and an ictal onset of abrupt bilateral frontal lobe desynchronization.
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