Authors :
Presenting Author: Michaela Stamm, MS – Brigham and Women's Hospital
Jack O'Keeffe Donohue, MB BCH BAO – Boston Children's Hospital Epilepsy Center
Alyssa Ailion, PhD – Boston Children's Hospital & Harvard Medical School
Jurriaan Peters, MD PhD – Boston Children's Hospital
Dana Martino, BS – Boston Children's Hospital
Giovanna Stefanini, BS – Boston Children's Hospital
Melissa Chua, MD – Brigham and Women's Hospital
Won Seok Chang, MD, PhD – Yonsei University
Heung Dong Kim, MD, PhD – Yonsei University
Seung Woo Hong, MS – Yonsei University
Jinu Rim, MD – Yonsei University
Diwas Gautam, BS – University of Utah
Shervin Rahimpour, MD – University of Utah
Robert Bollo, MD – University of Utah
Jasmine Hect, BS – University of Pittsburgh
Emily Harford, MA – Children's Hospital of Pittsburgh, UPMC
Taylor Abel, MD – Children's Hospital of Pittsburgh, UPMC
Jonathan Roth, MD – Tel Aviv Sourasky Medical Center
Shimrit Uliel-Sibony, MD – Tel Aviv Sourasky Medical Center
Vanessa Colares, MD – Sao Paulo Epilepsy Clinic
Arthur Cukiert, MD – Sao Paulo Epilepsy Clinic
Cristine Cukiert, MD – Sao Paulo Epilepsy Clinic
Megan Votoupal, BS – Ann & Robert H. Lurie Children's Hospital of Chicago
Sandi Lam, MD, MBA – Ann & Robert H. Lurie Children's Hospital of Chicago
Jeffrey Raskin, MS, MD – Ann & Robert H. Lurie Children's Hospital of Chicago
Sarah Ferrand-Sorbets, MD – Hopital Fondation Adolphe de Rothschild
Shaimae Afifi, BS – Hopital Fondation Adolphe de Rothschild
Jignesh Tailor, MD, PhD – Indiana University
Rupa Radhakrishnan, MD – Indiana University
Alexander Weil, MD – Centre Hospitalier Universitaire Sainte-Justine
Aristides Hadjinicolaou, MD – Centre Hospitalier Universitaire Sainte-Justine
Emma Macdonald-Laurs, MBChB – Royal Children’s Hospital Melbourne:
Kenneth Myers, MD, PhD – McGill University Health Centre
Mustafa Motiwala, MD – Le Bonheur Children's Hospital
Alister Virkler, BS – Children's Hospital of Philadelphia
Shanique Doyle, BS – Children's Hospital of Philadelphia
Benjamin Kennedy, MD – Children's Hospital of Philadelphia
Chien-Chen Chou, MD – Taipei Veterans General Hospital
Lily C. Wong-Kisiel, MD – Mayo Clinic, Rochester, MN, USA.
Aaron Warren, PhD – Brigham and Women's Hospital, Harvard Medical School
John Rolston, MD, PhD – Brigham and Women's hospital, Harvard Medical School
Rationale:
Corpus callosotomy (CC) is a treatment for severe epilepsy that involves disconnecting the corpus callosum—the primary pathway linking the brain’s hemispheres. Though tens of thousands have undergone CC worldwide, outcomes remain highly variable: some experience substantial seizure reduction and improved quality of life, while others derive limited benefit and may suffer long-term cognitive or motor effects. Efforts to improve patient selection have been hindered by three key barriers: (1) limited sample sizes at individual centers, (2) lack of infrastructure to harmonize clinical outcomes with biometric data, such as neuroimaging, and (3) poor understanding of the specific callosal pathways involved in seizure propagation. To address these gaps, we established the Multi-Center Callosotomy Outcomes Registry (M-CORE), pooling previously siloed data and enabling systematic investigation of predictors of CC outcomes (Fig. 1). We aim to describe preliminary findings from the registry and demonstrate its feasibility for guiding future research and improving patient care.Methods:
Demographic and clinical outcome data are collected via a custom REDCap survey. Pre- and postoperative MRI data are stored and analyzed at Mass General Brigham. We expect to collect data on n=400 patients who underwent treatment for seizures using CC. Patient data is retrospectively extracted from clinical records, with no limit on age or the time CC was performed.
Results:
In the current sample of 209 patients (Fig. 2), the average age of seizure onset is 2.2±2.9 yrs, with an average age at CC of 11.8±8.1 yrs. Most patients have a diagnosis of Lennox-Gastaut syndrome (51.2%), and the largest proportion have a genetic etiological type (29.2%). Most CCs were complete (71.3%) and were completed using an open surgical technique (91.4%). At 12±3 mos post-CC, of those with outcomes data available (n=147), 65 (44.2%) were free of drop seizures, 53 (36.1%) had improvement but were not free of drop seizures, and 29 (19.7%) did not have improvement of their drop seizures. Average time between CC and latest follow-up was 5.4±4.2 yrs. At latest follow-up, 66 (44.9%) were free of drop seizures, 59 (40.1%) had improvement but were not free of drop seizures, and 22 (15.0%) did not have improvement of their drop seizures.Conclusions:
CC is an effective treatment for drop seizures, with 85.0% of patients free of or having had improvement in drop seizures at long-term follow-up, in our interim analysis of 209 patients. When complete, M-CORE will form an open-access repository of neuroimaging and clinical outcome data from ~400 patients treated at multiple leading epilepsy centers. We have three future aims: (1) establish M-CORE and make it available to other investigators, (2) identify a therapeutic “sweet-spot” within the callosum where surgical disconnection is maximally effective, and (3) train a machine-learning classifier to predict outcomes using retrospective patient data, then share it with other centers to validate in new patients.Funding:
This research is supported by an infrastructure grant from the Pediatric Epilepsy Research Foundation.