SURGICAL APPROACHES TO EPILEPSY: SURGERY FOR OTHER TYPES OF SEIZURES – SECTIONING OF THE CORPUS CALLOSUM

The corpus callosum is the major pathway connecting one hemisphere of the brain with the other. Some seizures that are focal or multifocal in origin will spread throughout the cortex by the pathway of the corpus callosum to become generalized tonic-clonic seizures. Others will spread by this pathway to deeper structures and lead to atonic and minor-motor drop spells. When an individual is severely handicapped by these generalized seizures, and when the seizures are unresponsive to anticonvulsant medication, sectioning of the corpus callosum may prevent spread of the seizure and abolish the generalized component. Sectioning (cutting) of the corpus callosum does not stop focal seizures, and indeed may sometimes increase them, but focal seizures are more easily tolerated than generalized ones.
After this operation, often done in two stages, there is usually a 50 to 70 percent decrease in the atonic and generalized tonic-clonic seizures. There is little experience with this procedure in young children, where its success rate and its effect on the child’s developing nervous system are less understood.
This operation seems to be gaining support as more procedures are performed and the results better defined. Unlike the hemispherectomy patients, who seem to make important gains in intellectual function after surgery and sometimes improvement in their motor function as well, after corpus callosum section, children and adults seem less likely to experience substantial intellectual or motor improvement. The life of these individuals may be dramatically improved, however, with cessation of the akinetic seizures.
Surgery can sometimes provide “the answer” to seizures that are not controllable with medication and it can sometimes “cure” seizures that are focal or one-sided. Surgery is always worth considering.
But considering surgery is a multi-step process that requires careful evaluation at each step. Surgery itself is only the final step in the decision-making process.
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