Corpus Callosotomy and Epilepsy

Corpus Callosotomy and how it affects Epileptic Seizures

Capstone Research Paper

Neelam Ghatarora 784668

CLC 11 block D

M. Koshman

Friday April 12 2019

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Introduction

Epilepsy is a mental disorder that affects over 65 million people around the world. It is known as

one of the most common nervous system disorders and can affect people of any age, gender, race

or ethnicity. “Each year, about 150, 000 Americans are diagnosed with this central nervous

system disorder.” (Kimberly Holland, 2018) The severity of epilepsy is different for every

individual who is affected by it. Some people will face a large amount of changes to their

lifestyle, while others may only require a few. This disorder has the ability to greatly affect how

a person lives their everyday life and is much more common than we may realize.

What affects does epilepsy have on the brain and body?

What do you think of when you hear the word epilepsy? Majority of people would most likely

think of seizures. Epileptic seizures can be quite severe and frequent in many cases. The

symptoms tend to vary depending on the type of seizure being experienced. A few of the

common symptoms include temporary confusion, staring, uncontrollable jerking of the arms and

legs, loss of consciousness or awareness, and psychic symptoms including fear, anxiety or deja

vu. ”Doctors generally classify seizures as either focal or generalized.” (Mayo Clinic Staff, 2019)

Focal seizures are resulted in abnormal behaviour in just one single area of the brain. These can

be divided into two categories; with a loss of consciousness or with impaired awareness.

Generalized seizures result when all parts of the brain are being involved. There are multiple

kinds of generalized seizures. These include absence seizures, tonic seizures, atonic seizures,

clonic seizures, myoclonic seizures and tonic-clonic seizures. No matter what kind of seizure is

experienced, it can lead to many circumstances that cause danger to the individual as well as

others.
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The brain is an excessively complicated organ. There are millions of nerve cells, called neurons

that control everything we do in our lives. Neurons pass electrical signals through each other in

order to send information to and from the brain. Whenever something interrupts these signals or

too many signals are being sent at once, it results in a seizure. “A seizure is a burst of

uncontrolled electrical activity between brain cells that causes temporary abnormalities in

muscle, tone or movements.” (Johns Hopkins Health System, 2019) Our brains control mood,

memory, movement, consciousness and all of our other senses. Due to this, in the event of a

seizure the individual “may feel strange or confused, behave in an unusual way, or lose some or

all awareness during the seizure.” (Epilepsy society, 2006) Anybody can be at risk of having a

seizure; however, when an individual is dealing with multiple or recurring seizures, it is

diagnosed as epilepsy.

Every single day of our lives we complete so many tasks without even thinking about them. For

example, going to school or work may be considered quite simple for the average person. When

an individual has epilepsy, these everyday situations can cause quite a large amount of stress and

anxiety. Majority of people with epilepsy are completely capable of attending school full time.

However, there are many things that can create barriers. “Some children and adults may be at

risk for learning difficulties from the way seizures affect the brain or from other neurological

problems.” (Steven C Schachter, 2017) Another struggle that comes up is side effects of seizure

medicines. Doing certain types of work as well as finding a job can become harder due to

epilepsy. One of the biggest problems with working is how to get there. Many individuals who

face epileptic seizures cannot drive. This makes it difficult to get to work. Aside from these
Corpus Callosotomy and Epilepsy 4

issues, there are still quite a few occupations where the seizures will not get in the way of

performance. “In the United States, the American with Disabilities Act makes it illegal to deny

someone a job because of a medical condition if they can perform the essential duties of that

job.” (Steven C. Schachter, 2017) This act helps to benefit many individuals not only dealing

with epilepsy but any other medical conditions.

The Corpus Callosum and Corpus Callosotomy Surgery

The corpus callosum is a C-shaped bundle of nerve fibres across the midline of the mind that

allows the two hemispheres to communicate. “As recently as the mid 20th century, thee corpus

callosum was thought to serve no other purpose than preventing the two hemispheres from

collapsing on one another.” (Bogen, 1979) After much more research it was confirmed in the

1950’s that the corpus callosum is responsible for transmitting information back and forth,

between the two halves of the brain. If somebody were to tap your right shoulder, the

information would be sent through the body to the left hemisphere. From there, the corpus

callosum shares the message with the right hemisphere and the brain is quickly able to process

the information. The left and right hemispheres both have their own specialized areas; however,

they are constantly communicating and both halves work together to process incoming

information and coordinate responses.

The action of sharing information between the two hemispheres “adds to the spread of seizure

impulses from one side of the brain to the other.” (Cleveland Clinic, 2015) By taking the seizure

from one hemisphere and sharing it with the other, the corpus callosum causes generalization of
Corpus Callosotomy and Epilepsy 5

the seizure, including drop attacks or atonic seizures. Drop attacks cause an individual to

violently drop to the floor due to interrupted neurological messages. When a seizure occurs in

one area of the brain, the corpus callosum continues with its job to transfer the information with

the other hemisphere. Thus, resulting in the seizure being spread out to the entire brain. When

this action is taken, the individual experiences a generalized seizure; which makes a more intense

reaction occur. Epileptic seizures can very quickly escalate in intensity due to the communication

of the two hemispheres.

When multiple seizure medications fail to treat a patient dealing with generalized seizures and

drop attacks, a corpus callosotomy could be considered. Corpus callosotomy is sometimes

referred to as split-brain surgery. This operation is usually used to help treat individuals who

have “the most extreme and uncontrollable forms of epilepsy.” (Epilepsy Foundation, 2015)

Patients will go through a pre-surgery evaluation to help the doctor locate where the seizures are

beginning and how they spread. Once the patient is approved for the corpus callosotomy, they

will be put to sleep, using general anesthesia. Next, the surgeon makes a cut in the scalp using a

procedure known as craniotomy. Once a window is created, the hemispheres are gently separated

to reach the corpus callosum. The surgeon then makes a cut down the center of the corpus

callosum, stopping the communication between the two hemispheres. “In some cases, a corpus

callosotomy is done in two stages. In the first operation, the front two thirds of the structure is

cut, but the back section is preserved.” (Epilepsy Foundation, 2015) By only severing the front

two thirds, the hemispheres are still able to share visual information. However, if the serious

seizures are not controlled after the first operation, then the remainder of the corpus callosum is

cut during a second operation. Once the surgery is complete, the bone is placed back in the
Corpus Callosotomy and Epilepsy 6

correct way, and the scalp is closed using either stitches or staples. Corpus callosotomy often

takes about six hours to complete. After the operation, the patient will generally stay in the

hospital for two to four days. In most cases, the individual can continue their life regularly,

including school and work, in about six to eight weeks after the surgery.

The Results of a Corpus Callosotomy

Once an epileptic patient has undergone the corpus callosotomy operation, their seizures should

be reduced by a large amount. “Corpus callosotomy is successful in stopping drop attacks in

about 75 percent of cases. This can decrease the risk of injury and improve the person’s quality

of life.” (Cleveland Clinic, 2015) Although the procedure does not fully cure the seizures,

properly selected individuals have experienced an improvement in the frequency as well as the

severity of the epileptic seizures. Patients who suffer with drop attacks often respond the most

favourably; however, the lives of people who go through other seizure types can also be

improved by this operation. “By separating the cerebral hemispheres, the spread of an epileptic

discharge can be confined to one cortex, reducing generalized seizures.” (Epilepsy Foundation of

Greater Chicago, 2016) The effects of the drop attacks or convulsions are generally much less

severe once the corpus callostomy has been completed.

Serious problems with corpus callosotomy are very uncommon; however, with every surgery

come some side effects or potential risks. After corpus callosotomy symptoms such as scalp

numbness, nausea, feeling tired or depressed, headaches or difficulty speaking, remembering

things or finding the right words, may occur, but these generally disappear on their own after a
Corpus Callosotomy and Epilepsy 7

few weeks. It is very rare for these symptoms to persist. The surgeon who performs the surgery

on the individual is often able to inform you on what symptoms may occur. For some patients,

disconnection syndrome may be experienced. This happens in result of not being able to transfer

information between the two hemispheres. “If a child sees an object only with their left eye, the

right hemisphere will see the object but the information will not be transferred to the left

hemisphere. If the child’s left hemisphere is dominant for language, they will not be able to name

the object, even though they recognize it.” (SickKids staff, 2010) This side effect is not a large

issue and does not tend to affect the individuals life because majority of the time, information is

received through both eyes. Some patients may face physical weakness or loss of coordination.

This is usually easily fixed through some physical or exercise therapy. If speech is affected after

the surgery, the individual should attend speech therapy until they no longer need it.” Every

surgical procedure has related risks.” (SickKids staff, 2010) Some of these risks include

infection, bleeding, and cerebral edema. Although some risks may come with the operation of

corpus callosotomy, serious problems are very rare.

When an individual with epilepsy has completed a corpus callosotomy, the seizures become

much less frequent and severe. This is in result of the severing of the corpus callosum. Along

with helping the two hemispheres communicate with one another, the corpus callosum adds to

the spread of the seizure impulses being sent out. By cutting this band of nerve fibres, the

operation is “breaking the spread of seizure from hemisphere to hemisphere.” (Cleveland Clinic,

2015) The seizures do not completely end because the original start point of the seizure impulses

cannot be removed, however the split corpus callosum stops the process of generalization.

Therefore, the severity is lessened since the impulses cannot be shared throughout the entire
Corpus Callosotomy and Epilepsy 8

brain. Frequency of drop attacks are also decreased by a very large amount. This is because drop

attacks occur mostly in result of generalized seizures. Corpus callosotomy eliminates the

generalization of a focal seizure, which in return, cuts out the violent drop attacks that come with

it. Over 75 percent of patients who receive corpus callosotomy have resulted in an improved and

more profound lives.

Conclusion

“Epilepsy is the fourth most common neurological disease.” (Kimberly Holland, 2018) This

disorder causes an individual to experience recurrent seizures. When a person is having a seizure,

it is due to an interrupted neurological message in the brain. The severity varies depending on the

individual; however, these seizures can have a major impact a person’s daily life. “It’s like going

on a journey with a lot of peaks and valleys.” (Steven C. Schachter, 2017) To allow the two

hemispheres of our brains to communicate, the corpus callosum helps deliver the incoming

information and spread them throughout the entire brain. Therefore, it also contributes to

spreading the seizure impulses and causes generalization of the seizure. With corpus

callosotomy, the individuals who suffer from this violent disorder can lessen the frequency and

the intensity of their seizures, resulting in an overall more enjoyable life.

Corpus Callosotomy and Epilepsy 9

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