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Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy

 Yun Jung Hur  ;  Hoon-Chul Kang  ;  Dong Seok Kim  ;  Sae Rom Choi  ;  Heung Dong Kim  ;  Joon Soo Lee 
 BRAIN & DEVELOPMENT, Vol.33(8) : 672-677, 2011 
Journal Title
Issue Date
Child ; Child, Preschool ; Corpus Callosum/surgery* ; Electroencephalography ; Female ; Humans ; Infant ; Intellectual Disability/pathology* ; Intellectual Disability/physiopathology ; Intellectual Disability/surgery* ; Lennox Gastaut Syndrome ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Seizures/physiopathology ; Seizures/surgery* ; Spasms, Infantile/pathology* ; Spasms, Infantile/physiopathology ; Spasms, Infantile/surgery*
Lennox–Gastaut syndrome ; Corpus callosotomy ; Primary seizure foci
PURPOSE: Corpus callosotomy (CC) is a palliative surgical procedure to control atonic, tonic, or generalized tonic-clonic seizure in Lennox-Gastaut syndrome (LGS). Here, we report patients with LGS who underwent resective surgery, following CC better delineating the presumed seizure foci localized in one hemisphere.

METHODS: We retrospectively reviewed seven patients with LGS who underwent CC and subsequent cortical resection. The median follow-up duration after lobectomy was 20 months (range, 15-54 months) and three patients had follow-up periods over 24 months. The findings of video electroencephalography (EEG) monitoring, structural and functional neuroimagings were compared between pre- and post-CC.

RESULTS: Four patients had Engel class I and one patient had Engel class II outcomes following cortical resection; post-CC, compared to pre-CC, showed better localized ictal/interictal epileptiform discharges in the unilateral frontal area in two patients, in the unilateral parieto-temporo-occipital areas in one patient and in the unilateral fronto-temporal areas in the remaining two patients. Two patients had Engel Class III outcome following cortical resection; post-CC EEG continued to show multifocal epileptiform discharges but predominantly arising from a unilateral frontal area. Following CC, positron emission tomography showed localized glucose hypometabolism of which location was concordant with post-CC EEG abnormalities in all patient. Similarly, ictal/interictal single photon emission computed tomography also showed localized abnormalities concordant with post-CC EEG abnormalities in five of the six patients. Pathological assessment revealed cortical dysplasia in six patients, whereas no pathological abnormality was found in the remaining patient, who obtained Engel Class I outcome following cortical resection.

CONCLUSION: CC could change EEG findings, glucose metabolisms and cerebral blood flows, and it is sometimes helpful in delineating the primary seizure focus in patients with LGS.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Hoon Chul(강훈철) ORCID logo https://orcid.org/0000-0002-3659-8847
Kim, Dong Seok(김동석)
Kim, Heung Dong(김흥동) ORCID logo https://orcid.org/0000-0002-8031-7336
Lee, Joon Soo(이준수) ORCID logo https://orcid.org/0000-0001-9036-9343
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