Effect of corpus callosotomy on attention deficit and behavioral problems in pediatric patients with intractable epilepsy Takahiro Yonekawa a, ⁎, Eiji Nakagawa a , Eri Takeshita a , Yuki Inoue b , Masumi Inagaki b , Makiko Kaga b , Kenji Sugai a , Masayuki Sasaki a , Takanobu Kaido c , Akio Takahashi c , Taisuke Otsuki c a Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan b Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan c Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan abstract article info Article history: Received 23 June 2011 Revised 22 August 2011 Accepted 23 August 2011 Available online 5 October 2011 Keywords: Intractable epilepsy Drop attack Corpus callosotomy Attention deficit Behavioral disorders Child Behavior Checklist To evaluate the effect of corpus callosotomy (CC) on attention deficit and behavioral problems in pediatric patients with intractable epilepsy, we retrospectively investigated sequential patients who had undergone CC to control seizures. Between August 2005 and April 2010, a total of 15 patients aged between 3.1 and 17.9 years underwent CC at our institute. All the patients experienced either drop attacks or head nodding, which were considered to be therapeutic targets of CC. A standardized instrument, the Child Behavior Checklist (CBCL), was used to assess behavioral and emotional problems before and after surgery. On post- operative EEGs, 8 (53%) showed improvement and 7 (47%) showed no change in epileptiform discharges. The Attention Problems scale and total score on the CBCL significantly improved in patients whose postop- erative EEGs showed improvement. In addition to amelioration of target seizures, CC can improve attention impairments in association with improvement in the postoperative EEG. © 2011 Elsevier Inc. All rights reserved. 1. Introduction Chronic uncontrolled epilepsy in children represents a significant risk for deficits in emotional, behavioral, social, cognitive, and family functioning [1,2]. Although the primary goal of epilepsy surgery is to eliminate seizures, the child's mental, behavioral, and social functioning improves once the seizures are successfully eliminated [3–5]. This phenomenon has not been clarified in past studies because the most commonly reported outcome is seizure control. In general, corpus callosotomy (CC) is a palliative surgical proce- dure for patients who are not candidates for focal resective surgery despite their intractable seizures. CC best ameliorates drop attacks (tonic and atonic seizures) as well as tonic–clonic, absence, and fron- tal lobe complex partial seizures (CPS) [6]. The rationale underlying this procedure is based on the hypothesis that the corpus callosum is the most important pathway for interhemispheric spread of epilep- tiform activity [7]. With respect to the behavioral and neuropsycho- logical effects of CC, extensive investigations have been undertaken; however, to our knowledge, no studies have yet assessed these effects with the standardized instrument for assessment of children's behavioral problems known as the Child Behavior Checklist (CBCL), developed by Achenbach [8,9]. The aim of the present study was to assess, with the CBCL, behav- ioral and emotional problems in children who were candidates for CC and to evaluate whether postoperative improvement in EEGs or target seizures contributed to changes in specific behavioral and emotional problems. 2. Methods Written informed consent was obtained from the parents of all patients, according to the recommendations of the Declaration of Helsinki for investigations involving human subjects. 2.1. Patients Between August 2005 and April 2010, a total of 15 consecutive patients aged between 3.1 and 17.9 years underwent CC to control epileptic seizures at National Center Hospital, National Center of Neurology and Psychiatry. All patients were ambulatory and had had intractable epilepsy for more than a year. Drop attacks or head nodding resulting from tonic, atonic, or CPS was observed in all patients and constituted the most disabling seizure characteristics. These characteristics were considered targets of CC. Characteristics of all patients are provided in Table 1. Epilepsy & Behavior 22 (2011) 697–704 ⁎ Corresponding author at: Department of Child Neurology, NCNP, 4-1-1, Ogawa- Higashicho, Kodaira, Tokyo 187 8551, Japan. Fax: + 81 42 344 6745. E-mail address: yonekawa@ncnp.go.jp (T. Yonekawa). 1525-5050/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2011.08.027 Contents lists available at SciVerse ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh