Skip to main content

Advertisement

SpringerLink
Log in

Callosotomy for intractable epilepsy from bihemispheric cortical dysplasias

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Four patients suffering for severe drug-resistant epilepsy from bihemispheric cortical dysplasias underwent anterior callosotomy. One of these patients also presented mental retardation of mild degree associated with the epileptic syndrome. There were no operative complications in this series. Clinical signs of interhemispheric disconnection were not detectable postoperatively.

Twenty-eight to 53 months after surgery, the generalized seizures were completely suppressed in 2 cases, and were reduced by 89–97% in frequency in the other 2 cases. Partial seizures were less affected by callosotomy being reduced by 14–87%.

In an additional fifth case of intractable epilepsy from bihemispheric cortical dysplasias with associated severe mental retardation operated upon elsewhere for callosotomy and followed at our institution, the outcome for seizures was completely unsatisfactory.

Neurophysiological studies revealed that the interhemispheric transfer (IHT) of visuo-motor responses was functionally impaired after callosotomy only in one patient who harboured bilateral cortical dysplasias in the occipital lobes. This malformation might affect the pattern of axonal projection to the posterior portion of the corpus callosum which is considered of crucial importance for the integration of crossed visuo-motor responses.

From this paper the following conclusions can be drawn:

  1. a)

    epileptic patients with severe drug-resistant epilepsy due to bihemispheric cortical dysplasias are good candidates for callosotomy,

  2. b)

    one-stage extensive anterior callosotomy sparing the splenium is the procedure of choice,

  3. c)

    associated severe mental retardation seems to contra-indicate callosotomy,

  4. d)

    the neurophysiological study of the IHT can yield information on the functional status of the corpus callosum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aglioti S, Dali'Agnola R, Gireffi M, Marzi CA (1991) Bilateral hemispheric control of foot distal movements: evidence from normal subjects. Cortex 27: 571–581

    PubMed  Google Scholar 

  2. Aglioti S, Berlucchi G, Pallini R, Rossi GF, Tassinari G (1993) Hemispheric control of unilateral and bilateral responses to lateralized light stimuli after callosotomy and in callosal agenesis. Exp Brain Res 95: 151–165

    PubMed  Google Scholar 

  3. Andermann F, Olivier A, Melanson D,et al (1987) Epilepsy due to focal cortical dysplasia with macrogyria and the forma fruste of tuberous sclerosis: a study of 15 patients. In: Wolf Pet al (eds) Advances in epileptology, Vol 16. Raven, New York, pp 35–38

    Google Scholar 

  4. Bairamian D, DiChiro G, Theodore WH, Holmes MD, Dorwart RH, Larson SM (1985) MR Imaging and positron emission tomography of cortical heterotopia. J Comp Assist Tomogr 9: 1137–1139

    Google Scholar 

  5. Barkovich AJ, Chuang SH, Norman D (1987) MR of neuronal migration anomalies. AJNR 8: 1009–1017

    Google Scholar 

  6. Barkovich AJ, Jackson DE, Boyer RS (1989) Band heterotopias: a newly recognized neuronal migration anomaly. Radiology 171: 455–458

    PubMed  Google Scholar 

  7. Blume WT (1984) Corpus callosum section for seizures control: rationale and review of experimental and clinical data. Cleve Clin Q 51: 319–332

    PubMed  Google Scholar 

  8. Engel J Jr, Brown J, Kuhl DE, Phelps ME, Mazziotta JC, Crandell PH (1982) Pathologic findings underlying focal temporal lobe hypometabolism in partial epilepsy. Ann Neurol 12: 518–528

    PubMed  Google Scholar 

  9. Fuiks KS, Wyler AR, Hermann BP, Somes G (1991) Seizure outcome from anterior and complete corpus callosotomy. J Neurosurg 74: 573–578

    PubMed  Google Scholar 

  10. Hardiman O, Burke T, Phillips J, Murphy, O'Moore B, Staunton H, Farrell MA (1988) Microdygenesis in resected temporal neocortex: incidence and clinical significance in focal epilepsy. Neurology 38: 1041–1047

    PubMed  Google Scholar 

  11. Kuzniecky R, Garcia JH, Faught E, Morawetz RB (1991) Cortical dysplasia in temporal lobe epilepsy: magnetic resonance imaging correlations. Ann Neurol 29: 293–298

    PubMed  Google Scholar 

  12. Landy HJ, Ramsay RE, Ajmone-Marsan C, Levin BE, Beown J, Pasarin G (1992) Temporal lobectomy for seizures associated with unilateral schizencephaly. Surg Neuol 37: 477–481

    Google Scholar 

  13. Landy HJ, Curless RG, Ramsay RE, Slater J, Ajmone-Marsan C, Quencer RM (1993) Corpus callosotomy for seizures associated with band heterotopia. Epilepsia 34: 79–83

    PubMed  Google Scholar 

  14. Larroche JC (1977) Cytoarchitectonic abnormalities. In: Vincyn PJ, Brun GW (eds) Handbook of clinical neurology, Vol 30. Elsevier/North-Holland, Amsterdam, pp 492–493

    Google Scholar 

  15. Larroche JC (1984) Malformations in the nervous system. In: Adams JH, Corsellis JAN, Duchen LW (eds) Greenfield's neuropathology, 4th Ed. Wiley, New York, pp 421–429

    Google Scholar 

  16. Larroche JC, Razavi-Encha F (1987) Cytoarchitectonic abnormalities. In: Myriantopoulos NC (ed) Handbook of clinical neurology, Vol 6 (50). Elsevier, Amsterdam, pp 245–266

    Google Scholar 

  17. Layton DD (1967) Heterotoppic cerebral gray matter as an epileptic focus. J Neuropathol 121: 244–249

    Google Scholar 

  18. Leblanc R, Tampieri D, Robitaille Y, Feindel W, Andermann F (1991) Surgical treatment of intractable epilepsy associated with schizencephaly. Neurosurgery 29: 421–249

    PubMed  Google Scholar 

  19. Lemieux BG, Wright FS, Swaiman KF (1982) Genetic and congenital structural defects of the brain and spinal cord. In: Swaiman KF, Wright FS (eds) The practice of pediatric neurology, Vol 1. Mosby, St Louis, pp 424–425

    Google Scholar 

  20. Ludwin SK, Norman MG (1985) Congenital malformation of the nervous system. In: David RL, Robinson DM (eds) Textbook of neuropathology. Williams and Wilkins, Baltimore, pp 213–215

    Google Scholar 

  21. Mikhael MA, Matter AG (1978) Malformation of the cerebral cortex with heterotopia of the gray matter. J Comput Asst Tomogr 2: 291–296

    Google Scholar 

  22. Moreland DB, Franz EG, Egnatchik JG, Heffner RR, Alker GJ (1988) Focal cortical dysplasia. J Neurosurg 68: 487–490

    PubMed  Google Scholar 

  23. Naidich TP, Zimmerman RA (1987) Common congenital malformations of the brain. In: Brandt-Zawadzki M, Norman D (eds) Magnetic resonance imaging of the central nervous system. Raven, New York, pp 131–150

    Google Scholar 

  24. Nordberg C, Sourander P, Silvenius H,et al (1987) Mild cortical dysplasia in patients with intractable partial seizures. A histological study. In: Wolf Pet al (eds) Advances in epileptology, Vol 16. Raven, New York, pp 29–33

    Google Scholar 

  25. Nowell MA, Grossman RI, Packer R, Hackney DB, Goldberg MI, Bilaniuk LT, Zimmerman RA (1988) Focal cortical dysplasia on magnetic resonance imaging: a case report. J Comput Tomogr 12: 61–63

    PubMed  Google Scholar 

  26. Pandya DN, Rosene D (1985) Some observations on the trajectories and topography of commissural fibers. In: Reeves AG (ed) Epilepsy and the corpus callosum. Plenum, New York, pp 21–39

    Google Scholar 

  27. Ragazzo PC, Manzano GM, Marino R Jr (1988) Functional microsurgical callosotomy in patients with secondary generalized epilepsies. Appl Neurophysiol 51: 297–306

    PubMed  Google Scholar 

  28. Smith AS, Weinstein MA, Quencer RM,et al (1988) Association of heterotopic gray matter with seizures: MR imaging. Radiology 168: 195–198

    PubMed  Google Scholar 

  29. Spencer SS (1988) Corpus callosum section and other disconnection procedures for medically intractable epilepsy. Epilepsia 29 [Suppl 2] 85–99

    Google Scholar 

  30. Spencer SS, Spencer DD, Williamson PD (1988) Corpus callosotomy for epilepsy: seizure effects. Neurology 38: 19–24

    PubMed  Google Scholar 

  31. Stearns M, Wolf AL, Barry E, Bergey G, Gelland F (1989) Corpus callosotomy for refractory seizures in a patient with cortical heterotopia: case report. Neurosurgery 25: 633–636

    PubMed  Google Scholar 

  32. St. Jon R, Shields C, Timney B (1987) The reliability of estimates of interhemispheric reaction times derived from unimanual and verbal response latencies. Hum Neurobiol 6: 195–202

    PubMed  Google Scholar 

  33. Tassinari G, Aglioti S, Pallini R, Berlucchi G, Rossi GF (in press) Interhemispheric integration of simple visuomotor responses in patients with partial callosal defects. Behav Brain Res

  34. Taylor DC, Falconer MA, Bruton CJ, Corsellis JAN (1971) Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurgery Psychiatry 34: 369–387

    Google Scholar 

  35. Williamson PD (1985) Corpus callosum section for intractable epilepsy. Criteria for patient selection. In: Reeves AG (ed) Epilepsy and the corpus callosum. Plenum, New York, pp 21–39

    Google Scholar 

  36. Wilson DH, Reeves AG, Gazzaniga MS (1982) Central eommissurotomy for intractable epilepsy: series two. Neurology 32: 687–703

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institutes of Neurosurgery, Catholic University School of Medicine, Rome

    R. Pallini, S. Aglioti, G. Tassinari, G. Berlucchi, C. Colosimo & G. F. Rossi

  2. Institutes of Radiology, Catholic University School of Medicine, Rome

    C. Colosimo

  3. Institute of Human Physiology, University of Verona, Verona, Italy

    S. Aglioti, G. Tassinari & G. Berlucchi

Authors
  1. R. Pallini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Aglioti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Tassinari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Berlucchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Colosimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. F. Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pallini, R., Aglioti, S., Tassinari, G. et al. Callosotomy for intractable epilepsy from bihemispheric cortical dysplasias. Acta neurochir 132, 79–86 (1995). https://doi.org/10.1007/BF01404852

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01404852

Keywords

Search

Navigation