Abstracts

Rationale: Corpus callosotomy (CC) is a surgical treatment for medically intractable seizures, particularly of drop seizures. This treatment has been used for decades to reduce injury due to falls and generalized seizures. Evidence has been reported of decreased seizure frequency after CC; however, quality of life outcomes have not been well addressed in the current literature. It is often assumed that quality of life correlates with seizure frequency and severity. Therefore, we undertook a retrospective chart review of adult and pediatric patients who have undergone CC for medically intractable seizures to evaluate seizure outcomes. We also performed a prospective study to obtain patients /guardians perspective of patients current quality of life measures. Methods: After obtaining appropriate IRB approval, records were reviewed to identify all patients having undergone corpus callosotomy (CC) for refractory drop seizures at the Mayo Clinic between 1990 and 2009. Inclusion criteria consisted of age greater than 5 years; medically intractable seizures, including drop seizures, with no identified surgically resectable focus; and undergoing an anterior, complete, or anterior and later completed CC. Seizure types and frequency were recorded prior to and following CC in order to determine effectiveness of the procedure. Questionnaires, including the Hague Restrictions in Childhood Epilepsy Scale, the Impact of Childhood Epilepsy Scale, and the Quality of Life in Epilepsy (QOLIE-31) scale, were sent to all patients meeting inclusion criteria to assess current quality of life measures. Results: 43 patients were identified who met inclusion criteria. Questionnaires were returned by 16 patients, with 3 patients lost to follow up. Of the 16 patients, 10 consented to participate, 4 declined, and 2 were deceased. Among the 10 consented patients, the average age of seizure onset was 3 years. CC was performed as anterior 2/3rd (6), complete (3) or anterior followed later by completion (1). Atonic seizures were significantly decreased in 9/10 patients. Average quality of life score was rated as 4.3 on the 7-point modified Rankin scale, and 5.6 on the 10-point QOLIE-31 scale. Average overall health score was rated as 1.4 on a 4-point scale, and 5.6 on the 10-point QOLIE-31 scale. Average self esteem score was rated as 1.3 on a 4-point scale. Four of the 10 patients reported worsened cognitive or behavioral status following CC. Quality of life for this group was slightly worse (3.8 /- 1.3), than the group not reporting changes (4.7 /- 1.9). Conclusions: Corpus callosotomy is an effective surgical treatment for refractory drop seizures, resulting in a decrease in this seizure type in nearly all patients in this study. For these patients, on average, current quality of life after CC is reported as moderate. However, a trend was noted, although not significant, of a relationship between quality of life and cognitive outcomes, suggesting that worsened cognitive outcomes contributed to reporting a lower quality of life, despite improvement in drop attacks.