Corpus callosotomy in Lennox Gastaut syndrome

Corpus callosotomy is a palliative therapy option in patients with drop attacks or therapy-resistant bilateral tonic-clonic seizures (BTCS), particularly in Lennox Gastaut syndrome (LGS), if curative epilepsy surgery is not possible. This is the case in bilateral or multifocal lesions, pathologies near to eloquent areas or in non-lesional epilepsies. Before performing corpus callosotomy, a bilateral Wada test ensures that expressive and receptive language functions are located in the same hemisphere and that this hemisphere also drives the dominant hand. Otherwise, the patient is in danger of callosotomy-related antagonisms, disturbances of speech and severe apraxia. In contrast to curative epilepsy surgery, patients do not become seizure-free. Moreover, a corpus callosotomy bears more perioperative complications than usual epilepsy surgery (e.g. lesions because of pressure on structures lateral to the corpus callosum or venous infarction). Postoperatively, an acute disconnection syndrome in terms of listlessness regularly occurs which normally resolves within a short time. The outcome for tonic and atonic drop attacks and BTCS is favorable: According to the literature, > 80% of patients have a distinct reduction in seizure frequency for these seizure types and in approximately half of the patients these target seizures even disappear. Thus, corpus callosotomy, although infrequently performed, is a treatment option for patients with particularly dangerous and otherwise untreatable seizures.