Effect of corpus callosotomy on attention deficit and behavioral problems in pediatric patients with intractable epilepsy
Highlights
► The effect of corpus callosotomy on attention deficit is assessed. ► The Child Behavior Checklist is a valid assessment tool in children with epilepsy. ► In addition to ameliorating targeted seizures, corpus callosotomy can improve attention impairment. ► Improvement of attention deficit is associated with improvement of the electroencephalogram.
Introduction
Chronic uncontrolled epilepsy in children represents a significant risk for deficits in emotional, behavioral, social, cognitive, and family functioning [1], [2]. Although the primary goal of epilepsy surgery is to eliminate seizures, the child's mental, behavioral, and social functioning improves once the seizures are successfully eliminated [3], [4], [5]. This phenomenon has not been clarified in past studies because the most commonly reported outcome is seizure control.
In general, corpus callosotomy (CC) is a palliative surgical procedure for patients who are not candidates for focal resective surgery despite their intractable seizures. CC best ameliorates drop attacks (tonic and atonic seizures) as well as tonic–clonic, absence, and frontal lobe complex partial seizures (CPS) [6]. The rationale underlying this procedure is based on the hypothesis that the corpus callosum is the most important pathway for interhemispheric spread of epileptiform activity [7]. With respect to the behavioral and neuropsychological effects of CC, extensive investigations have been undertaken; however, to our knowledge, no studies have yet assessed these effects with the standardized instrument for assessment of children's behavioral problems known as the Child Behavior Checklist (CBCL), developed by Achenbach [8], [9].
The aim of the present study was to assess, with the CBCL, behavioral and emotional problems in children who were candidates for CC and to evaluate whether postoperative improvement in EEGs or target seizures contributed to changes in specific behavioral and emotional problems.
Section snippets
Methods
Written informed consent was obtained from the parents of all patients, according to the recommendations of the Declaration of Helsinki for investigations involving human subjects.
Characteristics of patients
Ten boys and five girls were recruited for the study. The median age at epilepsy onset was 1.8 years (range: 0.3–8.5). Nine (60%) patients were diagnosed with frontal lobe epilepsy, 3 (20%) with hemispheric congenital abnormality, and 3 (20%) with West or Lennox–Gastaut syndrome. The descriptive characteristics of the patients are summarized in Table 1. The median age at surgery was 6.5 years (range: 3.1–17.9), and the median duration of epilepsy prior to surgery was 4.5 years (range:
Discussion
In this study, we assessed, with the CBCL, behavioral and emotional problems in children who were candidates for CC and evaluated whether favorable target seizure outcome or improvement in postoperative interictal EEG were associated with changes in specific behavioral and emotional problems. A comparison between the pre- and postoperative Attention Problems scale t scores for patients with a favorable outcome showed no statistical differences (Fig. 2B). On the other hand, improvement in the
Conclusion
The present study indicates that CC significantly improved preoperative epileptiform discharges, implicated in the improvement of attention impairments. CC is a palliative procedure for cases of intractable epilepsy not amenable to focal resective surgery, and it can improve attention deficit and behavioral problems in association with improvement in diffusely propagated interictal epileptiform discharges.
Acknowledgments
This study was partly supported by Intramural Research Grants (21–5, 21–6, and 22–6: Clinical Research for Diagnostic and Therapeutic Innovations in Developmental Disorders) for Neurological and Psychiatric Disorders of NCNP.
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Cited by (15)
Developmental outcome after corpus callosotomy for infants and young children with drug-resistant epilepsy
2021, Epilepsy and BehaviorCitation Excerpt :Although the seizure-free rate after CC is not high compared to resective surgery, CC is reportedly effective for the treatment of drop attacks, secondary generalized tonic-clonic seizures, atypical absence seizures, and epileptic spasms [13,17–19]. Several studies have also reported CC-mediated improvements in cognitive function and behavioral deficits; however, the results vary among reports, due to differences in age at surgery and the period between onset and CC [17,20–22]. Therefore, the effect and impacts of CC in infancy and early childhood are still unclear.
Attention Deficit Hyperactivity Disorder and Associated Cognitive Dysfunction in Pediatric Epilepsy
2017, Seminars in Pediatric NeurologyCorpus callosum and epilepsies
2016, SeizureCitation Excerpt :Other generalized seizure types and partial seizures were improved to a lesser degree. Improvement in postoperative EEG was correlated with better seizure outcome [72,103]. Beside reduction of drop seizures positive changes in behavior, attention, overall daily and cognitive functions were reported [69,71,80,83,103].
Clinical profiles for seizure remission and developmental gains after total corpus callosotomy
2016, Brain and DevelopmentCitation Excerpt :Developmental gains after corpus callosotomy were better in patients with seizure freedom than in those without in this study. Behavioral improvement was frequently noted after corpus callosotomy in children with mental retardation and epilepsy [16,17]. However, longer follow-up study is necessary to know whether this developmental improvement continues for long-term.
Long-term seizure and behavioral outcomes after corpus callosotomy
2014, Epilepsy and BehaviorCitation Excerpt :Efficacy and relatively low permanent morbidity in CC have been demonstrated by more than sixty years of experience. Some recent studies have reported preserved cognitive functions and improved attention in the short period after surgery, confirming previous evidence of limited adverse effects on cognition [4–7]. However, CC is sometimes responsible for the well-known “disconnection syndrome” and other adverse effects, such as language impairments and memory deficits.