Abstract Details

Title Stereotactic Radiosurgery of Corpus Callosum in a Patient with Refractory Seizures: A Case Report

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 12-006

Objective We report a case of stereotactic radiosurgery (SRS) of corpus callosum in a patient diagnosed with Lennox-Gastaut Syndrome (LGS) and intractable epilepsy.

Background Corpus callosotomy is a surgical procedure whose aim is to reduce seizure frequency in patients with generalized or multifocal epilepsy who are not candidates for resection of a epileptic focus. Stereotactic radiosurgery (SRS) is a less invasive method than traditional surgery. It uses low-dose radiation to ablate the corpus callosum, disrupting the connectivity between both hemispheres and decreasing the generalization of seizures.

Design/Methods Case report and review of literature pertinent regarding SRS of corpus callosum.

Results A 26 year-old female with past medical history of Lennox-Gastaut Syndrome with multiple refractory types of seizures (tonic, atonic, atypical absence, myoclonic), was previously managed on 3 antiepileptic medications unsuccessfully. The patient underwent SRS callosotomy targeted to the rostrum, genu, and anterior third of body of the corpus callosum in 2013. After the operation, she had a dramatic decrease in severity and frequency of her seizures. The most improved types were atonic and generalized tonic-clonic seizures. Her follow up MRI showed thinning of the corpus callosum with asymmetric atrophy of left temporal lobe, particularly mesial temporal lobe.

Conclusions SRS carries low risk for complications as the low radiation is thought not to interfere with normal neural tissue in the short-term. 12.5% of the patients undergoing total callosotomy can develop a disconnect syndrome which is usually transient and more common in patient with Lennox-Gastaut syndrome or other intellectual disability. The long-term efficacy and safety profile of the procedure has yet to be analyzed by larger studies. Our patient was an example where seizures decreased several months after SRS. The improvement has been sustained since that time.

Authors/Disclosures
Bahareh Sianati, MD (Allegheny General Hospital - Neurology) PRESENTER	No disclosure on file
Arthur Alcantara Lima, MD	Dr. Alcantara Lima has nothing to disclose.
James P. Valeriano, MD (Allegheny Neurological Associates)	Dr. Valeriano has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for ucb. Dr. Valeriano has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for neurilis.