Corpus callosum stimulation and stereotactic callosotomy in the management of refractory generalized epilepsy: preliminary communication

Marino Jr., Raul; Gronich, Gary

doi:10.1590/S0004-282X1989000300012

Abstracts

Corpus callosum stimulation produced by chronically implanted electrodes, placed either by craniotomy or stereotactically, failed to control refractory generalized epilepsy in humans and also in experimentally produced penicillin epilepsy in cats. However, the patients that suffered, craniotomy, frontal lobe retraction or pneumoencephalograms, without callosal section, showed remarkable improvement of their seizure condition due to these, unspecific manipulation effects. Stereotactic anterior callosotomy emerged as a sequel of these functional neurosurgical findings, and as an alternative procedure to preclude undesirable neuropsychological and neurological side effects of split brain syndrome and of brain retraction, associated to conventional callosotomy. Ten patients with various disabling convulsive disorders have undergone this new operation, which showed to be less traumatic and better tolerated than open callosotomy.

A estimulação crônica do corpo caloso, obtida pela implantação de marca-passo e eletrodos implantados, colocados através de craniotomia ou estereotaxicamente, não controla, em humanos, ou em animais experimentais, a epilepsia generalizada refratária. Por outro lado, em pacientes craniotomizados, a retração do lobo frontal ou a realização de pneumen-cefalogramas, sem secção calosa, resultou em importante melhora do quadro convulsivo, em razão de efeitos inespecíficos de manipulação do encéfalo. A calosotomia estereotáxica anterior emergiu como conseqüência desses achados neurocirúrgicos funcionais e como procedimento alternativo para prevenir efeitos colaterais indesejáveis, tanto neuropsicológicos como neurológicos, tais como: 'split brain syndrome' e retração cerebral, associados à calosotomia convencional. Dez pacientes com vários tipos de síndromes convulsivas incapacitantes foram submetidos a esta nova intervenção, que se mostrou menos traumática e melhor tolerada que a calosotomia convencional a céu aberto.

Corpus callosum stimulation and stereotactic callosotomy in the management of refractory generalized epilepsy: preliminary communication

Estimulação do corpo caloso a calosotomia estereotáxica nas epilepsias generalizadas refratárias: comunicação preliminar

Raul Marino Jr.; Gary Gronich

Division of Functional Neurosurgery, University of São Paulo Medical School

SUMMARY

Corpus callosum stimulation produced by chronically implanted electrodes, placed either by craniotomy or stereotactically, failed to control refractory generalized epilepsy in humans and also in experimentally produced penicillin epilepsy in cats. However, the patients that suffered, craniotomy, frontal lobe retraction or pneumoencephalograms, without callosal section, showed remarkable improvement of their seizure condition due to these, unspecific manipulation effects. Stereotactic anterior callosotomy emerged as a sequel of these functional neurosurgical findings, and as an alternative procedure to preclude undesirable neuropsychological and neurological side effects of split brain syndrome and of brain retraction, associated to conventional callosotomy. Ten patients with various disabling convulsive disorders have undergone this new operation, which showed to be less traumatic and better tolerated than open callosotomy.

RESUMO

A estimulação crônica do corpo caloso, obtida pela implantação de marca-passo e eletrodos implantados, colocados através de craniotomia ou estereotaxicamente, não controla, em humanos, ou em animais experimentais, a epilepsia generalizada refratária. Por outro lado, em pacientes craniotomizados, a retração do lobo frontal ou a realização de pneumen-cefalogramas, sem secção calosa, resultou em importante melhora do quadro convulsivo, em razão de efeitos inespecíficos de manipulação do encéfalo. A calosotomia estereotáxica anterior emergiu como conseqüência desses achados neurocirúrgicos funcionais e como procedimento alternativo para prevenir efeitos colaterais indesejáveis, tanto neuropsicológicos como neurológicos, tais como: 'split brain syndrome' e retração cerebral, associados à calosotomia convencional. Dez pacientes com vários tipos de síndromes convulsivas incapacitantes foram submetidos a esta nova intervenção, que se mostrou menos traumática e melhor tolerada que a calosotomia convencional a céu aberto.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Acknowledgments - We are deeply indebted to the Hospital Albert Einstein of São Paulo, who provided the Magnetic Resonance exames; to C.H.P. Camargo for the Neuropsychological testing, and all our hospital staff who helped in the treatment of patients.

11. Marino R Jr - Functional microsurgical EEG guided and stereotactic callosotomy: two selective procedures for refractory generalized epilepsy (in preparation).

Divisão de Neurocirurgia Funcional, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - Caixa Postal 8091 - 01051 São Paulo SP - Brasil.

1. Avila JO, Radvany J, Huck FR, Camargo CHP, Marino R Jr, Ragazzo PC, Riva D, Arlant PA - Anterior callosotomy as a substitute for hemispherectomy. Acta Neurochirur 30 (Suppl): 137, 1980.
2. Camargo CHP, Makray RMA, Radvany J, Marino R Jr - Partial frontal callosotomy: a neuropsychological frontal lobe syndrome detected in the background of improvement of epilepsy. In Reeves AG (ed): Epilepsy and the Corpus Callosum. Plenum, New York, 1985, pg 435.
3. Cukiert A, Baumel SW, Andreolli M, Marino R Jr - Effects of corpus callosum stimulation on the morphology, frequency and synchrony of epileptic bursts in the feline topic penicillin generalized epilepsy model. Stereotact Funct Neurosurg 52:18, 1889 (Presented at the Epilepsy International Congress, Sept 1987, Jerusalem).
4. Delay J - Méthodes Biologiques en Clinique Psychiatrique (Chap 3: Les pneumotherapies cérébrales). Masson, Paris, 1950, pg 107.
5. Descrochers JL, Parenteau A, Hardy J - La réduction de la masse cérébrale dans le traitment de l'épilepsie incontrolable non focalisée. Can Med Ass J 85: 827, 1961.
6. Doose H - Myoclonic astatic epilepsy of early childhood. In Roger J, Dravet C, Bureau M (eds): Epileptic syndromes in Infancy, Childhood and Adolescence. John Libey Eurotext, London, 1985, pg 78.
7. Gates JR, Mireles R, Sharbroughs F, Maxwell R, Forb G - Magnetic resonance imaging, electroencephalogram and selected neuropsychological testing in staged corpus callosotomy. Arch Neurol 43: 1188, 1986.
8. Huck FR, Radvany J, Avila JO, Camargo CHP, Marino R Jr, Ragazzo PC, Riva D, Arlant PA - Anterior callosotomy in epileptics with multiforms seizures and bilateral synchronous spike and wave. Acta Neurochir 30 (Suppl): 127, 1980.
9. Marcus EM, Watson CW - Bilateral synchronous spike and wave electrographic patterns in the cat: interaction of bilateral cortical foci in the intact, the bilateral cortical-callosal and adiencephalic preparation. Arch Neurol 14: 601, 1966.
10. Marino R Jr - Surgery for epilepsy: selective partial micro-surgical callosotomy for intractable multiform seizures. Criteria for clinical selection and results. Appl Neu-rophysiol 48:404, 1985.
12. Marino R Jr, Ragazzo PC - Selection criteria and results of selective callosotomy. In Reeves AG (ed): Epilepsy and the Corpus Callosum. Plenum, New York, 1985, pg 281.
13. McKenzie TA, Seguin JJ, Stavraky GW - Effects of frontal lobectomy upon electrically induced convulsion and electronarcosis. Arch Neurol 2: 55, 1960.
14. Musgrave J, Gloor P - The role of the corpus callosum in bilateral interhemispheric synchrony of spike and wave discharge in feline generalized penicillin epilepsy. Epilepsia 21: 369, 1980.
15. Naquet R, Menini C, Catier J - Photically induced epilepsy in Papio papio: the role of the frontal cortex and of the corpus callosum. In Retsche H, Brazier MAB (eds): Synchronization of EEG Activity in the Epilepsies. Springer, New York, 1972, pg 347.
16. Penfield W, Jasper H - Therapeutic use of pneumography. In Epilepsy and the Functional Anatomy of the Human Brain. Little, Brown and Co, Boston, 1954, pg 564.
17. Sussman NM, Scanlon M, Garfinkle W, Callana M, O'Connor MJ, Harner RN - Magnetic resonance imaging after callosotomy. Neurology 37: 350, 1987.

Publication Dates

Publication in this collection
06 June 2011
Date of issue
Sept 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Avila JO, Radvany J, Huck FR, Camargo CHP, Marino R Jr, Ragazzo PC, Riva D, Arlant PA - Anterior callosotomy as a substitute for hemispherectomy. Acta Neurochirur 30 (Suppl): 137, 1980.

[2] 2. Camargo CHP, Makray RMA, Radvany J, Marino R Jr - Partial frontal callosotomy: a neuropsychological frontal lobe syndrome detected in the background of improvement of epilepsy. In Reeves AG (ed): Epilepsy and the Corpus Callosum. Plenum, New York, 1985, pg 435.

[3] 3. Cukiert A, Baumel SW, Andreolli M, Marino R Jr - Effects of corpus callosum stimulation on the morphology, frequency and synchrony of epileptic bursts in the feline topic penicillin generalized epilepsy model. Stereotact Funct Neurosurg 52:18, 1889 (Presented at the Epilepsy International Congress, Sept 1987, Jerusalem).

[4] 4. Delay J - Méthodes Biologiques en Clinique Psychiatrique (Chap 3: Les pneumotherapies cérébrales). Masson, Paris, 1950, pg 107.

[5] 5. Descrochers JL, Parenteau A, Hardy J - La réduction de la masse cérébrale dans le traitment de l'épilepsie incontrolable non focalisée. Can Med Ass J 85: 827, 1961.

[6] 6. Doose H - Myoclonic astatic epilepsy of early childhood. In Roger J, Dravet C, Bureau M (eds): Epileptic syndromes in Infancy, Childhood and Adolescence. John Libey Eurotext, London, 1985, pg 78.

[7] 7. Gates JR, Mireles R, Sharbroughs F, Maxwell R, Forb G - Magnetic resonance imaging, electroencephalogram and selected neuropsychological testing in staged corpus callosotomy. Arch Neurol 43: 1188, 1986.

[8] 8. Huck FR, Radvany J, Avila JO, Camargo CHP, Marino R Jr, Ragazzo PC, Riva D, Arlant PA - Anterior callosotomy in epileptics with multiforms seizures and bilateral synchronous spike and wave. Acta Neurochir 30 (Suppl): 127, 1980.

[9] 9. Marcus EM, Watson CW - Bilateral synchronous spike and wave electrographic patterns in the cat: interaction of bilateral cortical foci in the intact, the bilateral cortical-callosal and adiencephalic preparation. Arch Neurol 14: 601, 1966.

[10] 10. Marino R Jr - Surgery for epilepsy: selective partial micro-surgical callosotomy for intractable multiform seizures. Criteria for clinical selection and results. Appl Neu-rophysiol 48:404, 1985.

[11] 12. Marino R Jr, Ragazzo PC - Selection criteria and results of selective callosotomy. In Reeves AG (ed): Epilepsy and the Corpus Callosum. Plenum, New York, 1985, pg 281.

[12] 13. McKenzie TA, Seguin JJ, Stavraky GW - Effects of frontal lobectomy upon electrically induced convulsion and electronarcosis. Arch Neurol 2: 55, 1960.

[13] 14. Musgrave J, Gloor P - The role of the corpus callosum in bilateral interhemispheric synchrony of spike and wave discharge in feline generalized penicillin epilepsy. Epilepsia 21: 369, 1980.

[14] 15. Naquet R, Menini C, Catier J - Photically induced epilepsy in Papio papio: the role of the frontal cortex and of the corpus callosum. In Retsche H, Brazier MAB (eds): Synchronization of EEG Activity in the Epilepsies. Springer, New York, 1972, pg 347.

[15] 16. Penfield W, Jasper H - Therapeutic use of pneumography. In Epilepsy and the Functional Anatomy of the Human Brain. Little, Brown and Co, Boston, 1954, pg 564.

[16] 17. Sussman NM, Scanlon M, Garfinkle W, Callana M, O'Connor MJ, Harner RN - Magnetic resonance imaging after callosotomy. Neurology 37: 350, 1987.