Síndrome de desconexão inter-hemisférica após calosotomia total associada a comissurotomia anterior para tratamento de epilepsia resistente relato de um caso

Cendes, Fernando; Ragazzo, Paulo C.; Costa, Valter da; Martins, Luís F.

doi:10.1590/S0004-282X1990000300020

Resumos

Os autores fazem breve abordagem das indicações da calosotomia para tratamento de crises resistentes e relatam um caso em que ocorreu síndrome de desconexão inter-hemisférica clássica, após calosotomia total associada a comissurotomia anterior. A síndrome de desconexão foi mais severa nos primeiros 5 dias de pós-operatório, com boa melhora após o 11º dia, ocorrendo recuperação funcional quase completa e, também, redução significativa da freqüência das crises.

The authors provide a brief review of the indication criteria of callosotomy for the treatment of medically intractable seizures. They report a surgical case with the classical picture of disconnection (split brain) syndrome, following a two-staged complete callosotomy plus anterior commissurotomy. The disconnection syndrome was more severe on the first 5 days post-operatively, improving quickly after the 11th day; there was almost complete functional recovery and a great reduction in seizure frequency.

Fernando Cendes; Paulo C. Ragazzo; Valter da Costa; Luís F. Martins

Centro de Tratamento de Epilepsia, Instituto de Neurologia de Goiânia

RESUMO

Os autores fazem breve abordagem das indicações da calosotomia para tratamento de crises resistentes e relatam um caso em que ocorreu síndrome de desconexão inter-hemisférica clássica, após calosotomia total associada a comissurotomia anterior. A síndrome de desconexão foi mais severa nos primeiros 5 dias de pós-operatório, com boa melhora após o 11º dia, ocorrendo recuperação funcional quase completa e, também, redução significativa da freqüência das crises.

SUMMARY

The authors provide a brief review of the indication criteria of callosotomy for the treatment of medically intractable seizures. They report a surgical case with the classical picture of disconnection (split brain) syndrome, following a two-staged complete callosotomy plus anterior commissurotomy. The disconnection syndrome was more severe on the first 5 days post-operatively, improving quickly after the 11th day; there was almost complete functional recovery and a great reduction in seizure frequency.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. Paulo César Ragazzo - Instituto de Neurologia de Goiânia - Praça T-18 nº 140, Setor Bueno - 74860 Goiânia GO - Brasil.

1. Amacher AL - Midline commissurotomy for the treatment of some cases of intractable epilepsy: preliminary report. Childs Brain 2:54, 1976.
2. Barbizet J, Duizabo P - Manual de Neuropsicologia. Artes Médicas, Porto Alegre, 1985.
3. Geoffrey G, Lassonde M, Delisle F, Decarie M - Corpus callosotomy for control of intractable epilepsy in children. Neurology 33:891, 1983.
4. Gates JR, Rosenfeld WE, Maxwell RE, Lyons RE - Response of multiple seizure types to corpus callosum section. Epilepsia 28:28, 1987.
5. Habaugh RE, Wilson DH, Reeves AG, Gazzaniga MS - Forebrain commissurotomy for epilepsy: review of 20 consecutive cases. Acta Neurochir 68:263, 1983.
6. Kupfermann I - Hemispheric asymmetries and the cortical localization of higher cognitive and affective functions. In Kandel E, Schwartz PS (eds): Principles of Neural Science. Elsevier, Amsterdam, 1985.
7. Luessenhop AJ - Interhemispheric commissurotomy (the split brain operation) as an alternate to hemispherectomy for control of intractable seizures. Am J Surg 36:265, 1970.
8. Luessenhop AJ, de la Cuz TC, Fenichel GM - Surgical disconnection of the cerebral hemispheres for intractable seizures. J Am Med Assoc 213:1630, 1970.
9. Makari GS, Holmes GL, Murro AM - Corpus callosotomy for the treatment of intractable epilepsy in children. J Epilepsy 2:1, 1989.
10. Murro AM, Flanigin HF, Gallagher BB, King DW, Smith JR - Corpus callosotomy for the treatment of intractable epilepsy. Epilep Res 2:44, 1988.
11. Ochs R, Gloor P, Quesney LF, Ives J, Olivier A - Does headturning during a seizure have lateralizing or localizing significance? Neurology 34:884, 1984.
12. Riagazzo PC, Manzano GM, Marino R Jr - Functional microsurgical partial callosotomy in patients with secondary generalized epilepsies: I. Disruption of bilateral synchrony of spike and wave discharges. Appl Neurophysiol 51:297, 1988.
13. Risse GL, Gates JR, Lund G, Maxwell RE, Rubens A - Interhemispheric transfer in patients with incomplete section of the corpus callosum: anatomic verification with magnetic resonance imaging. Arch Neurol 46:437, 1989.
14. Spencer DD, Spencer SS - Corpus callosotomy in the treatment of medically intractable secondarily generalized seizures of children. Cleveland Clin J Med 56:869, 1989.
15. Spencer SS, Spencer DD, Williamson PD, Mattson RH, Sass KJ - Corpus callosotomy for epilepsy: I. Seizure effects. Neurology 38:19, 1988.
16. Van Wagenen WP, Herren RY - Surgical division of commissural pathways in the corpus callosum: relation to spread of an epileptic attack. Arch Neurol Psychiat 44:740, 1940.
17. Wada JA - New surgical treatment through experimental models. In Wada J, Penry JK (eds): Advances in Epileptology. Raven Press, New York, 1980, pg 195.
18. Walsh K - Neuropsychology: A Clinical Approach. Ed 2. Churchill Livingstone, New York, 1987.
19. Williamson PD, Spencer SS - Clinical and EEG features of complex partial seizures of extratemporal origin. Epilepsia 27:S46, 1986.
20. Wilson DH, Culver C, Waddington M, Gazzaniga M - Disconection of the control of intractable seizures. Neurology 25:1149, 1975.
21. Wilson DH, Reeves A, Gazzaniga M - Division of the corpus callosum for uncontrollable epilepsy. Neurology 28:649, 1978.

Síndrome de desconexão inter-hemisférica após calosotomia total associada a comissurotomia anterior para tratamento de epilepsia resistente relato de um caso

Interhemisphertc disconnection syndrome following total callosotomny associated to anterior commissurotomy for treatment of intractable epilepsy: case report

Datas de Publicação

Publicação nesta coleção
26 Maio 2011
Data do Fascículo
Set 1990

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

[1] 1. Amacher AL - Midline commissurotomy for the treatment of some cases of intractable epilepsy: preliminary report. Childs Brain 2:54, 1976.

[2] 2. Barbizet J, Duizabo P - Manual de Neuropsicologia. Artes Médicas, Porto Alegre, 1985.

[3] 3. Geoffrey G, Lassonde M, Delisle F, Decarie M - Corpus callosotomy for control of intractable epilepsy in children. Neurology 33:891, 1983.

[4] 4. Gates JR, Rosenfeld WE, Maxwell RE, Lyons RE - Response of multiple seizure types to corpus callosum section. Epilepsia 28:28, 1987.

[5] 5. Habaugh RE, Wilson DH, Reeves AG, Gazzaniga MS - Forebrain commissurotomy for epilepsy: review of 20 consecutive cases. Acta Neurochir 68:263, 1983.

[6] 6. Kupfermann I - Hemispheric asymmetries and the cortical localization of higher cognitive and affective functions. In Kandel E, Schwartz PS (eds): Principles of Neural Science. Elsevier, Amsterdam, 1985.

[7] 7. Luessenhop AJ - Interhemispheric commissurotomy (the split brain operation) as an alternate to hemispherectomy for control of intractable seizures. Am J Surg 36:265, 1970.

[8] 8. Luessenhop AJ, de la Cuz TC, Fenichel GM - Surgical disconnection of the cerebral hemispheres for intractable seizures. J Am Med Assoc 213:1630, 1970.

[9] 9. Makari GS, Holmes GL, Murro AM - Corpus callosotomy for the treatment of intractable epilepsy in children. J Epilepsy 2:1, 1989.

[10] 10. Murro AM, Flanigin HF, Gallagher BB, King DW, Smith JR - Corpus callosotomy for the treatment of intractable epilepsy. Epilep Res 2:44, 1988.

[11] 11. Ochs R, Gloor P, Quesney LF, Ives J, Olivier A - Does headturning during a seizure have lateralizing or localizing significance? Neurology 34:884, 1984.

[12] 12. Riagazzo PC, Manzano GM, Marino R Jr - Functional microsurgical partial callosotomy in patients with secondary generalized epilepsies: I. Disruption of bilateral synchrony of spike and wave discharges. Appl Neurophysiol 51:297, 1988.

[13] 13. Risse GL, Gates JR, Lund G, Maxwell RE, Rubens A - Interhemispheric transfer in patients with incomplete section of the corpus callosum: anatomic verification with magnetic resonance imaging. Arch Neurol 46:437, 1989.

[14] 14. Spencer DD, Spencer SS - Corpus callosotomy in the treatment of medically intractable secondarily generalized seizures of children. Cleveland Clin J Med 56:869, 1989.

[15] 15. Spencer SS, Spencer DD, Williamson PD, Mattson RH, Sass KJ - Corpus callosotomy for epilepsy: I. Seizure effects. Neurology 38:19, 1988.

[16] 16. Van Wagenen WP, Herren RY - Surgical division of commissural pathways in the corpus callosum: relation to spread of an epileptic attack. Arch Neurol Psychiat 44:740, 1940.

[17] 17. Wada JA - New surgical treatment through experimental models. In Wada J, Penry JK (eds): Advances in Epileptology. Raven Press, New York, 1980, pg 195.

[18] 18. Walsh K - Neuropsychology: A Clinical Approach. Ed 2. Churchill Livingstone, New York, 1987.

[19] 19. Williamson PD, Spencer SS - Clinical and EEG features of complex partial seizures of extratemporal origin. Epilepsia 27:S46, 1986.

[20] 20. Wilson DH, Culver C, Waddington M, Gazzaniga M - Disconection of the control of intractable seizures. Neurology 25:1149, 1975.

[21] 21. Wilson DH, Reeves A, Gazzaniga M - Division of the corpus callosum for uncontrollable epilepsy. Neurology 28:649, 1978.