Corpus callosotomy in Lennox-Gastaut syndrome: Effectiveness, safety, and predictors of outcome: A systematic review and meta-analysis.
Debopam Samanta, Praveen Kumar Ramani, Taylor J Abel et al.
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In 30 seconds
This systematic review and meta-analysis assessed corpus callosotomy (CC) effectiveness and safety for Lennox-Gastaut syndrome (LGS), synthesizing 48 studies involving 822 patients. The evidence comprised 46 retrospective and 2 prospective studies, with no randomized trials. The pooled rate of at least 50% seizure reduction was 69.6% (95% CI: 63.1-75.5%; I² = 24.1%; k = 48). Seizure freedom was 20.4% (95% CI: 16.0-25.7%; I² = 0.6%; k = 20), and complications occurred in 15.8% (95% CI, 10.4% - 23.2%). Certainty was rated very low.
Key findings
- At least 50% seizure reduction occurred in a pooled 69.6% of patients (95% CI: 63.1-75.5%; I² = 24.1%; k = 48).
- The pooled seizure-freedom rate was 20.4% (95% CI: 16.0-25.7%; I² = 0.6%; k = 20).
- Complications occurred in a pooled 15.8% (95% CI, 10.4% - 23.2%).
- Older age at surgery was the only significant independent predictor of at least 50% response in multivariable meta-regression (β = 0.045; p = 0.020); outcomes did not differ significantly by surgical extent or approach.
Why it matters
For drug-resistant LGS, these pooled findings quantify seizure outcomes and complications after CC across surgical approaches and age groups. They can inform discussions of potential benefit and harm, while the very low certainty of evidence means the estimates should be interpreted cautiously. The review also highlights the need for prospective, standardized, multicenter research.
What to keep in mind
Evidence came from observational studies only: 46 retrospective and 2 prospective, with no randomized trials. All outcomes were rated very low certainty, and non-seizure outcomes were limited.