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Fu RH, Wu PY, Chou IC, Lin CH, Hong SY. Demographic and clinical characteristics, seizure disorders, and antiepileptic drug usage in different types of corpus callosum disorders: a comparative study in children. Ital J Pediatr 2024; 50:20. [PMID: 38273353 PMCID: PMC10809518 DOI: 10.1186/s13052-024-01589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/07/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND This study aimed to investigate the demographic and clinical characteristics, types of seizure disorders, and antiepileptic drug usage among individuals with different types of corpus callosum disorders. METHODS A total of 73 individuals were included in the study and divided into three groups based on the type of corpus callosum abnormality: hypoplasia (H), agenesis (A), and dysgenesis (D). Demographic data, including gender and preterm birth, as well as clinical characteristics such as seizure disorders, attention deficit hyperactivity disorder (ADHD), severe developmental delay/intellectual disability, and other brain malformations, were analyzed. The types of seizure disorders and antiepileptic drugs used were also examined. RESULTS The H group had the highest number of participants (n = 47), followed by the A group (n = 11) and the D group (n = 15). The A group had the highest percentage of males and preterm births, while the D group had the highest percentage of seizure disorders, other brain malformations, and severe developmental delay/intellectual disability. The A group also had the highest percentage of ADHD. Focal seizures were observed in all three groups, with the highest proportion in the A group. Focal impaired awareness seizures (FIAS) were present in all groups, with the highest proportion in the D group. Generalized tonic-clonic seizures (GTCS) were observed in all groups, with the highest proportion in the H group. Different types of antiepileptic drugs were used among the groups, with variations in usage rates for each drug. CONCLUSION This study provided insights into the demographic and clinical characteristics, seizure disorders, and antiepileptic drug usage among individuals with different types of corpus callosum disorders. Significant differences were found between the groups, indicating the need for tailored management approaches. However, the study has limitations, including a small sample size and a cross-sectional design. Further research with larger sample sizes and longitudinal designs is warranted to validate these findings and explore the relationship between corpus callosum abnormality severity and clinical outcomes.
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Affiliation(s)
- Ru-Huei Fu
- Graduate Institute of Biomedical Sciences, China Medical University, 40402, Taichung, Taiwan
- Translational Medicine Research Center, China Medical University Hospital, 40447, Taichung, Taiwan
| | - Po-Yen Wu
- Division of Pediatric Neurology, China Medical University Children's Hospital, 2 Yuh-Der Road, 40447, Taichung, Taiwan
| | - I-Ching Chou
- Division of Pediatric Neurology, China Medical University Children's Hospital, 2 Yuh-Der Road, 40447, Taichung, Taiwan
- College of Chinese Medicine, Graduate Institute of Integrated Medicine, China Medical University, 40402, Taichung, Taiwan
| | - Chien-Heng Lin
- Division of Pediatrics Pulmonology, China Medical University Children's Hospital, 40447, Taichung, Taiwan
- Department of Biomedical Imaging and Radiological Science, College of Medicine, China Medical University, 40402, Taichung, Taiwan
| | - Syuan-Yu Hong
- Graduate Institute of Biomedical Sciences, China Medical University, 40402, Taichung, Taiwan.
- Division of Pediatric Neurology, China Medical University Children's Hospital, 2 Yuh-Der Road, 40447, Taichung, Taiwan.
- Department of Medicine, School of Medicine, China Medical University, 40402, Taichung, Taiwan.
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Guner YE, Comert A, Aslan A, Gungor Y. Corpus callosum area and sectioning: a radioanatomical study correlated with MRI and cadaver morphometry. Surg Radiol Anat 2023; 45:1427-1433. [PMID: 37488413 DOI: 10.1007/s00276-023-03206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The corpus callosum (CC) is the primary interhemispheric connection between the two cerebral hemispheres. Besides their similar morphological characters, there are differences in their measurements. This study aimed to divide the CC into groups using planes based on the anterior commissure (AC) and posterior commissure (PC) and to detect differences in CC magnetic resonance imaging (MRI) and cadaver samples between these groups. METHODS The study included 80 patients (40 male and 40 female patients) who underwent normal MRI in the midsagittal plane, and 38 cerebral hemispheres from 40 adult cadaver brains, with each hemisected in the midsagittal plane. The medial surface of the CC was divided vertically into three parts (the anterior, middle, and posterior zones) according to the AC and PC. Areas and parameters were measured in both the cadaveric hemispheres and patient MRI images. RESULTS The total CC area and CC areas between, anterior, and posterior to the AC-PC vertical lines were the same in both the MRI and cadaver samples. In addition, morphometric measurements like the CC length, AC-PC length, and CC height at the AC and PC vertical lines, and their correlations were also found to be similar between the MRI and cadaver samples. CONCLUSION This study proposes three areas according to AC and PC classification (anterior, middle, and posterior). This new proposed classification is suitable for stereotactic interventions and is useful for obtaining data from MRI images. However, it should be kept in mind that there may be changes and variations.
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Affiliation(s)
- Yahya Efe Guner
- Department of Neurosurgery, School of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | - Ayhan Comert
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey.
| | - Aydın Aslan
- Department of Radiology, School of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | - Yigit Gungor
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
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Arai Y, Okanishi T, Kanai S, Nakamura Y, Sunada H, Murakami H, Yamauchi K, Noma H, Maegaki Y. Prediction model for long-term seizure and developmental outcomes among children with infantile epileptic spasms syndrome. Front Neurol 2023; 14:1195252. [PMID: 37521298 PMCID: PMC10382128 DOI: 10.3389/fneur.2023.1195252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/05/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Children with infantile epileptic spasms syndrome (IESS) are likely to experience poor outcomes. Researchers have investigated the factors related to its long-term prognosis; however, none of them developed a predictive model. Objective This study aimed to clarify the factors that influence the long-term prognosis of seizures and their development and to create a prediction model for IESS. Materials and methods We conducted a retrospective cohort study enrolling participants diagnosed with IESS at the Tottori University Hospital. We examined the seizure and developmental status at 3 and 7 years after the IESS onset and divided the participants into favorable and poor outcome groups. Subsequently, we analyzed the factors associated with the poor outcome group and developed a prediction model at 3 years by setting cutoff values using the receiver operating characteristic curve. Results Data were obtained from 44 patients with IESS (19 female patients and 25 male patients). Three years after epileptic spasms (ES) onset, seizure and development were the poor outcomes in 15 (34.9%) and 27 (61.4%) patients, respectively. The persistence of ES or tonic seizures (TS) after 90 days of onset, moderate or severe magnetic resonance imaging abnormalities, and developmental delay before IESS onset were significantly associated with poor outcomes. Seven years after the onset of ES, seizures and development were the poor outcomes in 9 (45.0%) and 13 (72.2%) patients, respectively. We found that no factor was significantly associated with poor seizure outcomes, and only developmental delay before IESS onset was significantly associated with poor developmental outcomes. Our prediction model demonstrated 86.7% sensitivity and 64.3% specificity for predicting poor seizure outcomes and 88.9% sensitivity and 100% specificity for predicting poor developmental outcomes. Conclusion Our prediction model may be useful for predicting the long-term prognosis of seizures and their development after 3 years. Understanding the long-term prognosis during the initial treatment may facilitate the selection of appropriate treatment.
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Affiliation(s)
- Yuto Arai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Sotaro Kanai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuko Nakamura
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroshi Sunada
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Yonago, Japan
| | | | | | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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Inoue T, Kuki I, Uda T, Kunihiro N, Umaba R, Koh S, Nukui M, Okazaki S, Otsubo H. Comparing late-onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post-encephalitis/encephalopathy and non-encephalitis/encephalopathy. Epilepsia Open 2023; 8:346-359. [PMID: 36692212 PMCID: PMC10235586 DOI: 10.1002/epi4.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE We aimed to analyze the efficiency of corpus callosotomy (CC) and subsequent disconnection surgeries in patients with late-onset epileptic spasms (LOES) by comparing post-encephalitis/encephalopathy (PE) and non-encephalitis/encephalopathy (NE). We hypothesized these surgeries can control potential focal onset epileptic spasms (ES) in the NE group but not in the PE group. METHODS We retrospectively included 23 patients (12 with PE and 11 with NE) who initially underwent CC and subsequent disconnection surgeries (five NE). We compared the clinical courses, seizure types, MRI, video-EEG, epilepsy surgery, and seizure outcomes between the two groups. RESULTS The median age of LOES onset in the PE group was 2.8 (range 1.0-10.1 years) and 2.9 years (range 1.1-12.6) in the NE group. Bilateral MRI abnormalities were observed in both groups (PE, n = 12; NE, n = 3; P < 0.05). The PE group presented ES alone (n = 2), ES + focal seizures (FS) (n = 3), ES + generalized seizures (GS) (n = 3), and ES + FS + GS (n = 4) in addition to stimulus-induced startle seizures (SS) (n = 8) (mean 3.1 seizure types/patient). The NE group presented ES alone (n = 1), ES + FS (n = 2), and ES + FS + GS (n = 8) (mean 2.7 seizure types/patient). In the PE group, CC stopped ES (n = 1) and SS (n = 1) and achieved <50% SS (n = 3). In the NE group, CC achieved immediate ES-free status (n = 2) and < 50% ES (n = 1), and additional disconnection surgeries subsided all seizure types (n = 3) based on lateralized interictal/ictal EEG findings. LOES was significantly remitted by surgery in the NE group (6/11 [55%]) compared with the PE group (1/12 [8%]) (P < 0.05). SIGNIFICANCE LOES is a drug-resistant, focal/generalized/unknown onset ES. Lateralization of ES in NE could be achieved after CC and eliminated by further disconnection surgeries because of potential focal onset ES. LOES in PE had little benefit from CC for generalized onset ES. However, CC might reduce SS in patients in the PE group with multiple seizure types.
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Affiliation(s)
- Takeshi Inoue
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Ichiro Kuki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Takehiro Uda
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
- Department of NeurosurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Noritsugu Kunihiro
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
| | - Ryoko Umaba
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
| | - Saya Koh
- Department of NeurosurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Megumi Nukui
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
- Department of Pediatric LogopedicsOsaka City General HospitalOsakaJapan
| | - Shin Okazaki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
- Department of Pediatric LogopedicsOsaka City General HospitalOsakaJapan
| | - Hiroshi Otsubo
- Division of NeurologyThe Hospital for Sick ChildrenTorontoOntarioCanada
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Unexplained Progressive Neurological Deficits after Corpus Callosotomy May Be Caused by Autoimmune Encephalitis: A Case of Suspected Postoperative Anti-NMDAR Encephalitis. Brain Sci 2023; 13:brainsci13010135. [PMID: 36672116 PMCID: PMC9856623 DOI: 10.3390/brainsci13010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The main causes of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis are ovarian teratoma and herpes simplex virus (HSV) encephalitis. We present a rare case of suspected anti-NMDAR encephalitis caused by corpus callosotomy (CC). An 18-year-old woman with Lennox-Gastaut syndrome underwent CC. Although left hemiplegic due to cerebral hemorrhage and impaired consciousness due to cerebral venous sinus thrombosis (CVST) appeared postoperatively, anticoagulant therapy quickly improved CVST and impaired consciousness. However, various unexplained symptoms such as insomnia, hallucination, impulsivity, impaired consciousness, and a new type of drug-resistant cluster seizures gradually developed over a 2-month period. Magnetic resonance imaging revealed the gradual extension of a hyperintense area from the right frontal lobe on fluid-attenuated inversion recovery images. Intravenous methylprednisolone pulse was initiated from postoperative day (POD) 74, followed by intravenous immunoglobulin (IVIg) therapy, although white blood cell counts were normal in all three cerebrospinal fluid (CSF) examinations. After IVIg therapy, the above unexplained symptoms promptly improved. On POD 103, antibodies against NMDAR were revealed in both the serum and CSF collected before these immunotherapies. The patient was transferred to a rehabilitation hospital due to residual left hemiplegia. Psychiatric symptoms and a new onset of drug-resistant seizures may be suggestive of postoperative anti-NMDAR encephalitis, even if CSF findings are mild.
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Corpus Callosotomy: Editorial. Brain Sci 2022; 12:brainsci12081006. [PMID: 36009068 PMCID: PMC9405958 DOI: 10.3390/brainsci12081006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
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