Abstracts

Rationale: Corpus callosotomy (CC) is historicallyconsidered as the best palliative therapy for drop attacks,considered as the unique indication in most world epilepsy centers. This study aims to determine the role and effect of complete CC in refractory epilepsies with primary or secondary generalized seizures, different than atonic, due to the disconnection and subsequent desynchronization of the brain with this technique.Methods: This retrospective study included 17 patients with refractory epilepsy, with more than 1 year of follow up who underwent one-stage completeCC between years 2013 and 2014 at our institution. Theywere classified according tothe seizure type that was targeted to be controlled with this palliative surgery, excluding patients with atonic seizures. They were followed up using the Engel scale, and by analyzing persistence or absence of the targeted seizure. The average age at surgery was 11 years old (between 3 and 17 years old). Four patients already had VNS with no results, with atime average between VNS and CC, of 3.5 years.Results: 10 of 17 patients fulfill criteria of no atonic seizures as the main indication of total CC, 5 with several night GTC seizures with frequent status epilepticus, 2 patients with epileptic spams with Hipsarritmia, 2 with super-refractory status epilepticus and 1 with atypical absence status. 3 patients (30%) achieved seizure freedom (Engel class I), 2 patients (20%) achieved Class II, and 3 patients (30%) Class III, whereas 2 patients (20%) had a class IV outcome. 8 patients (80%) controlled the objective seizure. 6/8 showed significant improvement in their EEGs. Both patients with super-refractory status epilepticus had an Engel I outcome. The follow up average was 1.8 years.Conclusions: Our study shows thatcompleteCC permits an effective disconnection of the ongoing pathway in secondary generalizationseizures of refractory epilepsies andencefalopathies, with a secondary interhemisphericdesincronization. This implies an easier seizure control, improvement of theEEG pattern, a betterquality of life and eventual diminish of SUDEP risk. Complete CC must be considered as an effective and safe procedure to control super-refractory generalized SE andencefalopathies.