Evaluation of Outcome of Corpus Callosotomy in Management of Intractable Generalized Epilepsy

Abstract Epilepsy can remain uncontrolled despite multiple medications, making corpus callosotomy a practical palliative option for generalized or non-localizing seizures. It may reduce seizure severity, especially drop attacks, although it is rarely curative and carries some risks. To evaluate callosotomy outcomes and techniques, and also the advantages and limitations in managing intractable generalized epilepsy. The present study included 20 patients with medically refractory generalized seizures, unresponsive to 2 or more appropriate antiepileptic drugs, and without a resectable seizure focus. All patients underwent comprehensive evaluations, including detailed history (seizure onset, duration, frequency, family history, previous neurological events, drug history, seizure characteristics, drop attacks, and injuries), thorough physical and neurological examinations, neuropsychological assessment, and relevant investigations including video-electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) with Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS) protocol. In this series, children developed seizures early in life and underwent corpus callosotomy after prolonged drug-resistant epilepsy. Despite frequent, predominantly atonic seizures, surgery, mainly anterior callosotomy, resulted in seizure freedom or near-freedom in 70% of patients at approximately 15 months of follow-up, with few, mostly transient complications and no clear predictors of outcome. Corpus callosotomy is a practical and feasible palliative option for patients with intractable generalized epilepsy, particularly for controlling atonic seizures (drop attacks). It significantly reduces seizure-related injuries, activity limitations and caregiver dependence. An initial anterior two-thirds callosotomy is recommended for safety and to minimize cognitive risks, with completion to total callosotomy reserved for cases with inadequate seizure control.