First corpus callosotomy for medically refractory epilepsy in The Gambia: an international cooperation case report and historical review

BACKGROUND: Epilepsy affects over 50 million people worldwide, with the majority residing in low- and middle-income countries (LMICs) where access to specialized care is often constrained. Surgical intervention represents a crucial therapeutic modality for patients with medically refractory epilepsy, yet epilepsy surgery remains markedly underutilized in sub-Saharan Africa. CASE PRESENTATION: We report the case of a 10-year-old boy in The Gambia with medically refractory epilepsy characterized by daily drop attacks. Despite optimized and adequately trialed therapy with carbamazepine and sodium valproate, he continued to experience disabling seizures, leading to recurrent head trauma. Computed tomography (CT) and magnetic resonance imaging (MRI) did not reveal an identifiable structural lesion. Given the intractability of seizures and significant associated morbidity, he underwent a corpus callosotomy. The procedure was performed via a standard microsurgical approach and concurrently addressed the resection of traumatic calcified scalp hematomas. The patient's postoperative recovery was uneventful, and he was discharged on postoperative day 13 and remained seizure-free. At the six-month postoperative follow-up, the patient achieved complete freedom from drop attacks, with generalized tonic-clonic seizures (GTCS) occurring only during periods of antiseizure medication (ASM) interruption. CONCLUSIONS: This case highlights the feasibility and therapeutic potential of epilepsy surgery in the context of a surgical program within a resource-limited setting. Scaling up access to epilepsy surgery in comparable environments could contribute to mitigating the global epilepsy treatment gap.