Surgical and developmental outcomes of corpus callosotomy for West syndrome in patients without MRI lesions.

Abstract

This retrospective study was designed to assess the impact of corpus callosotomy (CC) in patients with intractable West syndrome (WS) without lesions on magnetic resonance imaging (MRI). This study involved 56 patients with WS who underwent CC between January 2000 and December 2014. Seizure outcomes and changes in psychomotor development were analyzed. Mean age at the onset of epilepsy and at the time of CC was 5.1 and 22.6months, respectively. Mean duration of epilepsy before CC was 17.6months. Video-electroencephalography (EEG) monitoring showed bilateral ictal and interictal abnormalities before CC. Mean follow-up duration was 36.6months. At final follow-up, seizure outcomes after CC were seizure-free in 18 patients (32.1%), excellent (E: >80% reduction in seizure frequency) in 15 (26.8%), good (G: >50% reduction) in 10 (17.9%), and poor (P: <50% reduction) in 13 (23.2%). Epileptic spasms (ES) were eliminated in 24 patients (42.9%). However, tonic seizure (TS) outcomes were poor (P<0.05). Of preoperative predictive factors related to seizure outcome, developmental delay before epilepsy onset correlated with poor outcome (P<0.05). One year post-CC, 6 patients (10.7%) had no epileptic abnormality on EEG, 19 (33.9%) had lateralized epileptic abnormalities, and 31 (55.4%) had bilateral asynchronous epileptic abnormalities. All patients without epileptic discharge achieved seizure freedom. Fifteen of 19 (78.9%) patients in the lateralized group and 12 of 31 (38.7%) in the bilateral asynchronous group had worthwhile outcomes (F+E). The patterns of EEG changes after CC correlated with seizure outcome (P<0.01). Progressive declines in developmental quotient were prevented in patients with worthwhile outcomes. CC represents an important therapeutic option for patients with WS without resectable MRI lesions. Transcallosal seizure bilateralization is critical for bilateral ES generation. Early identification of potential CC candidates and surgical intervention are important for better seizure control and cognitive capacity preservation before severe developmental delay development.