Unterberger Iris, Bauer Richard, Walser Gerald, Bauer Gerhard
Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
Department of Neurosurgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria.
Seizure. 2016 Apr;37:55-60. doi: 10.1016/j.seizure.2016.02.012. Epub 2016 Mar 3.
Corpus callosum (CC) is the largest forebrain commissure. This review focuses on the significance of CC for seizure disorders, the role of CC in seizure spread and the surgical disruption of callosal fibers (callosotomy) for treatment of patients with drug-resistant epilepsy.
Personal experience/extensive literature review.
Structural CC pathologies comprise developmental abnormalities, callosal involvement in identified disorders, transient imaging findings and microstructural changes. Epilepsies are reported in up to two thirds of patients with complete or partial CC agenesis (AgCC). However, AgCC per se is not indicative for seizure disorders. Moreover, additional malformations of cortical development (MCD) are causal. Microstructural CC abnormalities are detected by advanced imaging techniques, are part of diffuse white matter disturbances and are related to cognitive deficits. The etiological significance remains unexplained. However, they are also found in non-epileptic benign and transient disorders. In drug-resistant epilepsies with violent drops to the floor ("drop seizures") callosotomy may be beneficial in seizure reduction. Since the EEG after callosotomy exhibits a single seizure focus in up to 50% of patients, consecutive resective surgical methods might be successful.
CC is part of cerebral white matter and anomalies cannot act per se as seizure onset zone. Imaging techniques demonstrate additional lesions in patients with epilepsies. CC is the major pathway for seizure generalization. Therefore, callosotomy is used to prevent generalized drop seizures.
胼胝体（CC）是最大的前脑连合。本综述聚焦于CC在癫痫疾病中的意义、CC在癫痫传播中的作用以及胼胝体纤维切断术（胼胝体切开术）对耐药性癫痫患者的治疗作用。
个人经验/广泛的文献综述。
CC的结构病变包括发育异常、胼胝体在特定疾病中的受累情况、短暂性影像学表现和微观结构变化。据报道，在多达三分之二的完全或部分胼胝体发育不全（AgCC）患者中存在癫痫。然而，AgCC本身并不预示癫痫疾病。此外，额外的皮质发育畸形（MCD）才是病因。先进的影像学技术可检测到CC的微观结构异常，这些异常是弥漫性白质紊乱的一部分，且与认知缺陷有关。其病因学意义尚不清楚。然而，在非癫痫性良性和短暂性疾病中也可发现这些异常。在有剧烈跌倒发作（“跌倒发作”）的耐药性癫痫中，胼胝体切开术可能有助于减少癫痫发作。由于胼胝体切开术后脑电图在多达50%的患者中显示单一癫痫病灶，后续的切除性手术方法可能会成功。
CC是脑白质的一部分，其异常本身不能作为癫痫发作起始区。影像学技术显示癫痫患者存在其他病变。CC是癫痫泛化的主要途径。因此，胼胝体切开术用于预防全身性跌倒发作。
