First corpus callosotomy in The Gambia frees boy of disabling drop attacks

A ten-year-old boy in The Gambia who suffered up to ten dangerous drop attacks a day has become the first patient in the country to undergo a corpus callosotomy, an epilepsy operation that disconnects the two hemispheres of the brain. The surgery, described in a case report published in Acta Epileptologica, was carried out at Edward Francis Small Teaching Hospital as part of an emerging epilepsy surgery program built on local surgical capacity and international collaboration. Six months after the operation, the boy’s mother reported that his drop attacks had stopped completely, and his generalized tonic–clonic seizures recurred only when his family could not afford to keep up his antiseizure medications.

The case matters far beyond one child. Epilepsy affects more than 50 million people worldwide, and nearly 80 percent of them live in low- and middle-income countries, where the treatment gap may exceed 75 percent. Sub-Saharan Africa carries a particularly heavy burden, driven by infectious causes, birth trauma, genetic predisposition, and constrained access to health care. Antiseizure medications are the standard first-line treatment, but the African region reports the lowest mean utilization of these drugs, at roughly 24.5 percent, reflecting inadequate access to pharmacotherapy. Studies from high-income countries indicate that up to one-third of people with epilepsy develop drug-resistant disease, while the epidemiology of treatment refractoriness in low- and middle-income countries remains less clearly delineated and may differ because of variations in etiology, treatment accessibility, and health system factors.

The surgical backlog is enormous. By current estimates, more than 10 million patients with epilepsy could benefit from surgery, with the greatest proportion of potential candidates in low- and middle-income countries, particularly Africa and Latin America. Researchers emphasize that this burden largely represents a backlog of unmet need rather than a higher incidence of epilepsy: where surgical services are scarce, patients who are medically refractory and surgically eligible simply accumulate. A recent review found that publications on epilepsy surgery originated from only 22 percent of low- and middle-income countries, a stark measure of how unevenly this capability is distributed.

The boy’s history illustrates why surgery became necessary. His seizures began at ten months of age, and by the time of referral he was experiencing frequent drop attacks, sudden falls caused by atonic seizures, up to ten times daily, alongside generalized tonic–clonic seizures up to three times daily. He had been treated with carbamazepine and then sodium valproate, the only antiseizure medications accessible and affordable to his family; no other drugs were tried because of limited access and financial constraints. He tolerated both agents without documented adverse effects, but neither controlled his drop attacks, which caused repeated head trauma. On examination at the neurosurgery clinic he was nonverbal but interacted with his mother, moved purposefully, and walked independently. He had multiple chronic traumatic forehead lesions and calcified subgaleal hematomas, the physical residue of years of uncontrolled falls. Developmentally, he had significant expressive language delays and had never attended school, owing to seizure frequency, safety concerns, and limited access to specialized educational resources. His constant need for supervision imposed a substantial caregiving burden on his family.

Preoperative evaluation relied on the diagnostic tools actually available in The Gambia. Cranial computed tomography and magnetic resonance imaging confirmed the calcified frontal scalp lesions and an intact corpus callosum, with no evidence of intracranial structural abnormalities. Scalp electroencephalography, interpreted in collaboration with an international tele-EEG service, showed generalized epileptiform discharges without a consistent focal onset or lateralizing features. Specialized resources such as long-term video-EEG monitoring, intracranial EEG, and formal neuropsychological assessment were not available, so the team based its decision on clinical semiology, scalp EEG, and structural neuroimaging. The authors note an important caveat for such settings: the absence of a lesion on available imaging reflects the limits of the diagnostic technology rather than a definitive absence of focal pathology.

With no resectable focus identified and injurious drop attacks dominating the picture, the multidisciplinary team, including local neurosurgery and neurology, anesthesia providers, and international epilepsy surgery collaborators, chose a total corpus callosotomy to maximize the chance of reducing atonic seizures, a choice informed by prior evidence that complete callosal sectioning controls drop attacks better than anterior callosotomy alone. The operation used standard microsurgical instruments, an operating microscope, and routinely available anesthesia equipment. Through a coronal incision and bifrontal craniotomy, the surgeons took an interhemispheric approach, identified the corpus callosum, and sectioned it from rostrum to splenium in a posterior trajectory, using the vein of Galen as a landmark. The dura was closed with non-absorbable sutures, the bone flap secured with titanium plates and screws, and the calcified frontal scalp hematomas were burred down flush with the adjacent calvarium. Informed consent was obtained from the patient’s parent.

The postoperative course was uncomplicated. The boy was drowsy on postoperative day one, resumed oral intake on day two, and began physiotherapy and ambulation on day four. No seizures were reported during his hospitalization. He received perioperative intravenous ceftriaxone, later switched to oral amoxicillin-clavulanate, along with intravenous phenytoin and standard analgesics. He was discharged at his neurologic baseline on postoperative day 13. At six-month follow-up, his mother reported complete cessation of drop attacks since surgery. Generalized tonic–clonic seizures recurred only during episodes of medication non-adherence caused by financial difficulties and were otherwise controlled with consistent dosing. No new seizure types appeared, no surgical complications such as infection, hemorrhage, or new neurologic deficits occurred, and caregivers reported improved safety, less need for constant supervision, and fewer traumatic injuries. The overall outcome corresponds to Engel Class ID, because tonic–clonic seizures persisted during periods of medication interruption. Postoperative MRI was not obtained because of prohibitive out-of-pocket cost, and formal neuropsychological testing was unavailable, so assessment of cognitive effects relied on clinical observation and caregiver report.

The report places this operation in a sobering historical context. Epilepsy care in The Gambia has long been hindered by stigma, insufficient infrastructure, and a scarcity of neurologists and neurosurgeons. Early surveys documented a lifetime epilepsy prevalence of 4.9 per 1000, with fewer than one in ten patients able to maintain continuous treatment despite 80 percent being potentially controllable with low-cost medications. At the time, only phenytoin, phenobarbital, and carbamazepine were widely available, every surveyed patient had sought traditional remedies such as exorcisms, amulets, and herbal treatments, and stigma was profound, with many individuals reportedly disowned or excluded from school and employment. Yet 61 percent said they would prefer preventive biomedical treatment if it were locally accessible. The absence of EEG capacity, a single neurologist, and no neurosurgeons combined to perpetuate the treatment gap. Collaboration between local teams and international partners has since helped build a neurosurgical workforce and train providers in epilepsy management, and since August 2021 a partnership between the Foundation for Epilepsy and Stigma Support in The Gambia and TeleEEG in the United Kingdom has kept EEG services available in the country, while the foundation’s radio, television, and social media campaigns work to dispel misconceptions.

The authors argue that corpus callosotomy is unusually well suited to resource-limited settings because it requires no implants or specialized consumables, unlike responsive neurostimulation or vagus nerve stimulation, which depend on expensive devices and long-term device management. Other procedures, including lesionectomy for well-defined focal lesions, hemispherectomy for hemispheric syndromes, and anterior temporal lobectomy, can often be performed with relatively limited facilities, whereas intracranial EEG monitoring and laser interstitial thermal therapy demand resources that typically keep them out of reach. The case also shows how financial and logistical constraints shape outcomes at every stage: the pathway to surgery involved repeated healthcare visits, time away from work for caregivers, and medication adherence repeatedly disrupted by cost, and even brief interruptions in antiseizure therapy precipitated seizure recurrence after an otherwise successful operation.

The report’s authors are candid about its limits. It is a single-patient case with only six months of follow-up, no standardized quality-of-life assessments, and no formal neuropsychological testing to detect disconnection syndrome. Longer-term outcomes, including one-year follow-up, will be needed to establish durability, and systematic longitudinal data collection is still under development within the program, with future aims of prospective case series and a local epilepsy registry. Broader availability also remains constrained by workforce shortages, inconsistent access to medications, and the lack of comprehensive epilepsy monitoring infrastructure, making such interventions most viable within structured programs supported by sustained local training and international collaboration rather than as a broadly available standard of care. Even so, the authors conclude that expanding access to epilepsy surgery through local training, international partnership, and targeted infrastructure investment will be essential to narrowing the treatment gap, and they suggest that emerging digital tools such as large language models may eventually help identify and triage surgical candidates at Edward Francis Small Teaching Hospital and similar centers.

Subject of Research: The first corpus callosotomy performed in The Gambia for a child with medically refractory epilepsy, within an emerging internationally supported epilepsy surgery program.

Article Title: First corpus callosotomy for medically refractory epilepsy in The Gambia: an international cooperation case report and historical review

Article References: Gal, Z. T., Manneh, E. K., Gupta, S., Luiselli, G. A., Cham, M., Ceesay, A., Nyassi, M., Jobe, Y., Oguocha, R., Barry, M., Gomez, M. F., Jammeh, M., Bojang, O., Jagne, T., Jallow, F., Njie, A., Jallow, C. S., Bittaye, M., Joof, M., … Jabang, J. N. (2026). First corpus callosotomy for medically refractory epilepsy in The Gambia: an international cooperation case report and historical review. Acta Epileptologica, 8(1), Article 17. https://doi.org/10.1186/s42494-026-00258-2

Image Credits: AI Generated

DOI: 10.1186/s42494-026-00258-2

Keywords: epilepsy, corpus callosotomy, epilepsy surgery, The Gambia, drug-resistant epilepsy, drop attacks, low- and middle-income countries, neurosurgery, treatment gap, case report, global health, tele-EEG