Seizure outcome after corpus callosotomy in a large paediatric series.

AIM: To describe 20 years of experience with corpus callosotomy at Great Ormond Street Hospital for Children, London and the Children's Hospital at Westmead, Sydney.

METHOD: Records of patients who underwent corpus callosotomy between January 1995 and December 2015 were reviewed. Complications of surgery and changes in seizure type and frequency, injuries, and use of antiepileptic drugs were recorded. Drop attacks were analysed using Kaplan-Meier event-free survival curves. Multivariable regression analysis was used to assess the effect of clinical characteristics on outcome at last follow-up.

RESULTS: Inclusion criteria were met for 55 patients younger than 18 years of age. Median follow-up length was 36 months. At the last follow-up, 26 out of 55 patients (47%) had rare or no drop attacks. In those without a good outcome at final follow-up, 26 out of 29 (90%) had drop attacks return within 12 months of surgery. There were no preoperative predictors of developing drop attacks postoperatively. The median number of antiepileptic drugs significantly reduced from three to two. Transient neurological complications were experienced by 11 out of 55 patients (20%) and 6 out of 55 patients had surgical complications (11%).

INTERPRETATION: Corpus callosotomy is a well-tolerated procedure that is effective at reducing the severity of drop attacks in paediatric patients. Drop attacks that do return are likely to do so within 12 months and the number of antiepileptic drugs can be significantly reduced.

WHAT THIS PAPER ADDS: Corpus callosotomy is an effective palliative treatment and well tolerated in children. Good outcomes for the first 12 months after surgery were likely to continue. The number of antiepileptic drugs can be significantly reduced after corpus callosotomy. Patients with fewer than three types of seizure had better outcomes. There were fewer injuries from drop attacks after surgery.