Callosal lesions and behavior: history and modern concepts

Abstract

Callosotomy has played a unique role in the treatment of epilepsy and in the understanding of human brain function. The pioneering work of Dejerine and Liepmann presenting the first findings of callosal lesion pathology at the turn of the 20th century was accepted but then quickly forgotten. Two schools resurrected the phoenix of callosal syndromes: Roger Sperry and Michael Gazzaniga leading in experimental neuroscience, and Norman Geschwind leading in clinical neurology. Callosotomy remains an effective technique to treat atonic, tonic, and tonic-clonic seizures, especially in patients with symptomatic generalized epilepsies such as Lennox-Gastaut syndrome. Neurologic, cognitive, and behavioral complications limit its use given that precise characterization of these complications as well as their frequency is difficult. The high frequencies of developmental delays, severe seizures, head injuries, antiepileptic drug burden, and other factors limit the ability to attribute a specific change to surgical intervention, since surgery can change multiple factors. For example, subtle behavioral changes in executive function and personality are difficult to delineate in a population with preexisting neurologic and psychiatric disorders. Despite this, a clearer picture of the effects of callosotomy, as defined by clinical neurology and neuropsychology as well as cognitive neuroscience, is emerging.