Corpus Callosotomy or Focal Surgery in Children Presenting With Generalized Tonic Seizures: Findings From the Pediatric Epilepsy Research Consortium

Authors

• Cemal Karakas, Division of Pediatric Neurology, Department of Neurology, University of Louisville, Norton Children's Hospital, Louisville, Kentucky; Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia. Electronic address: [email protected].
• Aaron E. Warren, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
• Juliet K. Knowles, Department of Neurology, Stanford University School of Medicine, Stanford, California.
• M Scott Perry, Cook Children's Medical Center, Jane and John Justin Institute for Mind Health, Fort Worth, Texas.
• Avery Caraway, Cook Children's Medical Center, Jane and John Justin Institute for Mind Health, Fort Worth, Texas.
• Lily Wong-Kisiel, Divisions of Child Neurology and Epilepsy, Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.
• Pradeep Javarayee, Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
• Joffre Olaya, Department of Neurosurgery, Children's Hospital Orange County, Orange, California.
• Daniel Shrey, Department of Neurosurgery, Children's Hospital Orange County, Orange, California.
• Samir Karia, Division of Pediatric Neurology, Department of Neurology, University of Louisville, Norton Children's Hospital, Louisville, Kentucky.
• Jeetendra Sah, Division of Pediatric Neurology, Department of Neurology, University of Louisville, Norton Children's Hospital, Louisville, Kentucky.
• Adam P. Ostendorf, Department of Pediatrics, Nationwide Children's, Ohio State University, Columbus, Ohio.
• Priyamvada Tatachar, Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois.
• Allyson L. Alexander, Department of Neurosurgery, University of Colorado, Children's Hospital Colorado, Aurora, Colorado.
• Krista Eschbach, Section of Neurology, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado.
• Jeffrey Bolton, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
• Shilpa B. Reddy, Department of Pediatric Neurology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, Nashville, Tennessee.
• Michael J. McCormack, Department of Pediatric Neurology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, Nashville, Tennessee.
• Rani Singh, Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina.
• Dewi Depositario-Cabacar, Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia.
• Michael Ciliberto, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
• Jason Coryell, Doernbecher Children's Hospital, Oregon Health and Sciences University, Oregon Health Science Center, Portland, Oregon.
• Erin Fedak Romanowski, Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
• Nancy McNamara, Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
• Ernesto Gonzalez- Giraldo, Benioff Children's Hospital, University of California San Francisco Weill Institute for Neurosciences, San Francisco, California.
• Kurtis Auguste, Benioff Children's Hospital, University of California San Francisco Weill Institute for Neurosciences, San Francisco, California.
• Nilika Shah Singhal, Benioff Children's Hospital, University of California San Francisco Weill Institute for Neurosciences, San Francisco, California.
• Dave F. Clarke, Department of Neurology and Pediatrics, Dell Medical School, UT Health, Austin, Texas.

Document Type

Journal Article

Publication Date

3-4-2026

Journal

Pediatric neurology

Volume

178

DOI

10.1016/j.pediatrneurol.2026.02.020

Keywords

Characteristics; Corpus callosotomy; Epilepsy surgery; Outcomes; Tonic seizure

Abstract

BACKGROUND: To elucidate the clinical profiles and surgical outcomes of patients with generalized tonic seizures (GTSs) undergoing corpus callosotomy (CC) or focal surgery (FS). METHODS: Subjects with GTS undergoing CC or FS were identified using the Pediatric Epilepsy Research Consortium surgery database. Between-group comparisons were performed to assess differences in presurgical epilepsy characteristics and postsurgical seizure outcomes. RESULTS: Fifty-four patients (CC: 40 and FS: 14) included. Patients in the CC group had seizure onset at an older age (median = 1 year vs 0.4 years; P = 0.022), and were older at referral for phase-1 evaluation (median = 11.2 years vs 4.85 years; P = 0.026), and at time of surgery (median = 14 years vs 5.6 years; P = 0.008). The CC group showed higher rates of developmental delay (90% vs 57%; P = 0.013) and greater number of antiseizure medications attempted before surgery (median = 6 vs 4; P = 0.049). Electroencephalography localization also differed (P = 0.002), being most commonly generalized (64%, CC group) and multifocal (45%, FS group). Structural magnetic resonance imaging abnormalities were more common in FS group (92% vs 48%, P = 0.008). Median follow-up duration was 13.2 months (interquartile range = 5-24) in the CC group and 13.5 months in the FS group (interquartile range = 8-18). At last follow-up, FS group had a higher rate of seizure freedom (80% vs 19%; P = 0.0006). CONCLUSIONS: Our findings demonstrate differences in baseline characteristics and postsurgical outcomes of patients with GTS referred for FS and CC. FS yielded high seizure-freedom rates in focal cases. For patients with no discernible seizure focus, CC was often delayed, though outcomes were generally favorable and delays likely unwarranted.

APA Citation

Karakas, Cemal; Warren, Aaron E.; Knowles, Juliet K.; Perry, M Scott; Caraway, Avery; Wong-Kisiel, Lily; Javarayee, Pradeep; Olaya, Joffre; Shrey, Daniel; Karia, Samir; Sah, Jeetendra; Ostendorf, Adam P.; Tatachar, Priyamvada; Alexander, Allyson L.; Eschbach, Krista; Bolton, Jeffrey; Reddy, Shilpa B.; McCormack, Michael J.; Singh, Rani; Depositario-Cabacar, Dewi; Ciliberto, Michael; Coryell, Jason; Romanowski, Erin Fedak; McNamara, Nancy; Giraldo, Ernesto Gonzalez-; Auguste, Kurtis; Singhal, Nilika Shah; and Clarke, Dave F., "Corpus Callosotomy or Focal Surgery in Children Presenting With Generalized Tonic Seizures: Findings From the Pediatric Epilepsy Research Consortium" (2026). GW Authored Works. Paper 8933.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8933

Department

Neurology