Callosotomy for epilepsy after West syndrome

Purpose: To analyze the results of callosotomy in 17 children with symptoma tic generalized epilepsy after West syndrome, according to the different se izure types and surgical procedures, to define selection criteria for candi dates to callosotomy. Methods: Callosotomy was performed in two successive stages. Partial callos otomy, anterior in 13 and posterior in three, was followed by completion in 14 cases in all but four patients (complete callosotomy in one stage in on e, no completion in three). All patients had clinical, video-EEG, and neuro psychological evaluation before and after each stage of callosotomy, with a mean final follow-up of 4 years. Results: Seizure frequency improved in only two of 13 patients after anteri or callosotomy, in none of three after posterior callosotomy, but in nine o f 14 after complete callosotomy. After complete callosotomy, spasms disappe ared in 80% of cases, and drop attacks, the most severe ictal event, comple tely stopped or were dramatically reduced in 90% of the children. One patie nt no longer had episodes of status epilepticus, and another one acquired t he ability to walk after complete callosotomy. From the cognitive viewpoint , nine patients with improved seizure frequency after complete callosotomy also had improved behavior and cognitive functions, but two others experien ced speech deterioration after posterior callosotomy at age: 11 years and c ompletion of callosotomy at age 16 years. Conclusions: As in other severe generalized epilepsies in childhood, drop a ttacks provide the best indication for complete callosotomy in patients wit h previous West syndrome. Because drop attacks can be identifiable by falls only, the previous acquisition of walking should be considered as a key fe ature for any benefit to be obtained.