Indications and results of callosotomy in children.

Partial or complete section of the corpus callosum is still today a controv ersial procedure. Callosotomies are principally effective only oil a specif ic type of seizures, characterised by drop attacks. The fall is cine to eit her to a sudden collapse (atonic seizure) or to a tonic axial phenomenon in cluding often an injury. These seizures decrease between 60 to 100% in freq uency for 70 to 80% of rite cases. Sometimes, drop attacks are completely s uppressed. These drop attacks occur in different epileptic syndroms and ar- e associated with other types of seizures which are less susceptible to be treated by callosotomy. The best results are obtained for drop attacks asso ciated with unilateral cerebral lesions and for bilateral frontal lobe epil epsy. In these indications, a good result is obtained for 65 to 75% of the patients. Between 0 to 13% according to the series, are completely seizure- free. For the Lennox-Gastaut syndrome, results ar-e considered as questionn able. In this situation, callosotomy obviously is ineffective. Not only cal losotomies are as much effective in children as in adults, but functionnal tolerance is better in children. Another unresolved problem is the actual b enefit arising from a decrease of one type of seizure in patients who exper ience different seizure types and who have other associated neurological ha ndicaps. On the basis of our own experience, a significant improvement in s ocial adjustement seem to be linked not only to the efficacy on seizures, b ut also on the precocity of the surgical net. In conclusion, it seems to Ir s that callosotomy is a procedure which should be proposed mainly in childr en.