Therapeutics and Clinical Risk Management (Jul 2019)
Corpus callosotomy might have reduced epileptic seizure-induced repetitive shoulder joint dislocation in two patients with medically intractable epilepsy who were not focus resection candidates
Abstract
Kazuki Sakakura, Ayataka Fujimoto, Naoki Ichikawa, Keishiro Sato, Hideo Enoki, Tohru OkanishiComprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu JapanPurpose: Treatment options appear lacking for patients with epileptic seizure-induced shoulder dislocations who are not candidates for shoulder and focus resection surgeries. To reduce shoulder joint dislocations caused by epileptic seizures and simultaneously reduce the frequency and intensity of seizures, we performed corpus callosotomy for two patients with medically intractable epilepsy that induced repetitive shoulder joint dislocations.Materials and methods: A 21-year-old man (Patient 1) with bilateral temporal lobe epilepsy [Focal onset impaired awareness seizure (FIAS), 1/month; focal to bilateral tonic-clonic seizure (BTCS), 1/2–3 months], autism and intellectual disorder and a 34-year-old man (Patient 2) with left multi-lobar epilepsy (BTCS, 3–4/month; status epilepticus, 1/2–3 months), autism and intellectual disorder had suffered from repetitive seizure-induced shoulder dislocations (1/2–3 months for Patient 1; 3–4/month for Patient 2). Due to frequent seizures and uncooperativeness, they were not candidates for shoulder joint dislocation surgery. They were also not candidates for focus resection surgery due to multiple foci and uncooperativeness for invasive monitoring. We performed corpus callosotomy for both patients.Results: Postoperatively, frequencies of both shoulder dislocations (2 in 5 years of follow-up for Patient 1; 1 in 5 months of follow-up for Patient 2) and epileptic seizures were drastically reduced.Conclusions: For patients who are not candidates for focus resection and shoulder joint surgeries but who suffer from frequent shoulder joint dislocations, corpus callosotomy could be a treatment of last resort.Keywords: shoulder dislocation, corpus callosotomy, Bankart repair, Bristow procedure, medically intractable epilepsy
