Treatment of seizures in subcortical laminar heterotopia with corpus callosotomy and lamotrigine

Focal and generalized cortical dysgeneses are sometimes seen on the magneti c resonance images (MRI) of patients with epilepsy. Subcortical laminar het erotopia are bilateral collections of gray matter in the centrum semiovale that resemble a band or "double cortex" on MRI. We studied one male and two female patients with subcortical laminar heterotopia who had moderate to s evere developmental delay, early-onset epilepsy, and medically refractory s eizures. Atonic, atypical absence, tonic, myoclonic, complex partial, and g eneralized tonic-clonic seizures were recorded. Interictal and ictal electr oencephalographic patterns were generalized and, less commonly, multifocal. Two years after corpus callosotomy, one patient was free of generalized to nic-clonic and atonic seizures, but the other patient who had undergone cal losotomy had no significant reduction in seizure frequency. With lamotrigin e treatment, the patient who had not had surgery had complete cessation of monthly episodes of status epilepticus and a dramatic reduction of generali zed tonic-clonic seizures, and the other patient who received lamotrigine h ad a 50% reduction of her atonic seizures. Ln patients with subcortical lam inar heterotopia, atonic and generalized tonic-clonic seizures can be subst antially reduced or eliminated by corpus callosotomy or treatment with lamo trigine.