Elsevier

Epilepsy & Behavior

Volume 22, Issue 4, December 2011, Pages 697-704
Epilepsy & Behavior

Effect of corpus callosotomy on attention deficit and behavioral problems in pediatric patients with intractable epilepsy

https://doi.org/10.1016/j.yebeh.2011.08.027Get rights and content

Abstract

To evaluate the effect of corpus callosotomy (CC) on attention deficit and behavioral problems in pediatric patients with intractable epilepsy, we retrospectively investigated sequential patients who had undergone CC to control seizures. Between August 2005 and April 2010, a total of 15 patients aged between 3.1 and 17.9 years underwent CC at our institute. All the patients experienced either drop attacks or head nodding, which were considered to be therapeutic targets of CC. A standardized instrument, the Child Behavior Checklist (CBCL), was used to assess behavioral and emotional problems before and after surgery. On postoperative EEGs, 8 (53%) showed improvement and 7 (47%) showed no change in epileptiform discharges. The Attention Problems scale and total score on the CBCL significantly improved in patients whose postoperative EEGs showed improvement. In addition to amelioration of target seizures, CC can improve attention impairments in association with improvement in the postoperative EEG.

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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