Long-term outcomes of corpus callosotomy in adult patients with drug-resistant epilepsy: Results from a single neurosurgical center in Mexico.

OBJECTIVE

Corpus callosotomy (CC) is a commonly indicated palliative surgery for drug-resistant epilepsy (DRE). While younger age at the time of surgery is a well-established positive prognostic factor, there is limited evidence on long-term outcomes in adult patients with DRE. A study that evaluates seizure control at various follow-up points is necessary to better understand the outcomes of CC.

METHODS

In this retrospective longitudinal cohort, we included adult CC patients operated on by our institution's epilepsy surgery service between 1993 and 2023. We compiled epilepsy etiology, preoperative seizure frequency, and postoperative seizure outcomes at <1 year of follow-up, 1-3 years of follow-up, and >3 years of follow-up. Our outcomes were seizure freedom and response rate (50% frequency decrease from preoperative).

RESULTS

We analyzed data from 63 patients. The most common indication for CC was DRE due to Lennox-Gastaut Syndrome. Median seizure frequency had a significant decrease from preoperative (70 seizures per month [spm], IQR = 16-210) to the 1 year of follow-up (4 spm, IQR = 0-20, p = <0.0001), 1-3 years of follow-up (8 spm, IQR = 1-30, p = <0.0001), and >3 years of follow-up (7 spm, IQR = 2.25-30, p = <0.0001). Seizure freedom at 1 year postoperative decreased from 25.4% to 10.3% at 1-3 years (p = 0.032), while the overall response rate of our sample remained consistent, being 81% at 1-year follow-up and 70% at the long-term follow-up (p = 0.20). There were 10 postoperative complications, with 5 cases of neurological deficits.

SIGNIFICANCE

We identified that CC effectively decreases seizure frequency in adult patients with DRE. The reduction of seizure frequency after CC remained consistent after the first postoperative year. Prospective clinical trials are needed to better understand the long-term outcomes of CC in adults.

PLAIN LANGUAGE SUMMARY

This study analyzed the outcomes of corpus callosotomy (CC) in adult patients with drug-resistant epilepsy. We identified that CC is a safe and effective long-term treatment, with 70% of patients experiencing significant seizure reduction and 11% achieving seizure freedom. While most existing evidence supports CC in children, our findings support its efficacy in adult patients as well.