Extended, One-stage Callosal Section for Treatment of Refractory Secondarily Generalized Epilepsy in Patients with Lennox–Gastaut and Lennox-like Syndromes

Summary: Purpose: We report on the efficacy and safety ofextended one-stage callosal section performed in a large andhomogeneous series of patients. Methods: Seventy-six patients with Lennox–Gastaut (n =28)and Lennox-like (n = 48) syndrome were studied (42 male pa-tients; mean age, 11.2 years). All patients had multiple seizuretypes per day, including atonic, tonic–clonic, atypical absence,myoclonic, and tonic seizures. All of them were developmen-tally impaired. The EEG showed intense secondary bilateralsynchrony in all of them. All patients were submitted to an ex-tended, one-stage, callosal section, leaving only the spleniumintact. Mean follow-up time was 4.7 years. Results: Worthwhile improvement ( > 50%) was noted in 69of 76 patients; 52 patients had a ≥90% reduction in seizurefrequency. Seven patients were seizure free after surgery. Theseizure patterns most responsive to surgery were atonic (92%),atypical absence (82%), and tonic–clonic (57%) seizures. Allpatients had some degree of a transient acute postoperative dis-connection syndrome. A consistent increase in attention levelwas observed postoperatively.