Seizure freedom after leucotomy in a childhood refractory epilepsy associated with schizencephaly and multifocal cortical malformation

Schizencephaly associated with extensive malformation of cortical developments frequently cause medically intractable epilepsy in pediatric patients. Because of the extent of the structural abnormality, which is often bihemispheric and multifocal, epileptic surgery in these group of patients is typically not considered or indicated. We report a 10-year-old boy with medically intractable epilepsy and multifocal epileptiform discharges associated with bilateral malformation of cortical developments, schizencephaly, and agenesis of the corpus callosum, initially thought to be not a candidate for epilepsy surgery. All of the seizures localized to the right posterior head region. Seizure freedom was achieved after a right temporoparietooccipital (TPO) disconnection. He was followed postoperatively for 22 months at which time he remained on oxcarbazepine monotherapy. We emphasize that medically intractable epileptic patients with unilateral schizencephaly, bilateral colpocephaly, and multifocal epileptiform discharges must be evaluated with a video electroencephalography (VEEG) to characterize the seizures before ruling out epilepsy surgery as a therapeutic option. TPO disconnection surgery, instead of multilobar resections, can result in favorable seizure outcome in patients with localized seizure onset in the posterior head region.