First Corpus Callosotomy in The Gambia as a Step Forward in Neurosurgical Care
For a ten-year-old boy in The Gambia, each day carried the same risk. Several times a day, his body would suddenly give way, and he would fall. These seizures, known as “drop attacks,” did not resemble the kind of epileptic seizures most people imagine. Over the years, these falls shaped his life, but also the life of his mother.
This case is described in the article titled First Corpus Callosotomy for Medically Refractory Epilepsy in The Gambia: An International Cooperation Case Report and Historical Review, authored by Zsombor T. Gal, Ebrima K. Manneh, Saksham Gupta, Gabrielle A. Luiselli, Makumba Cham, Ancha Ceesay, Mai Nyassi, Yusupha Jobe, Richard Oguocha, Musa Barry, Mary F. Gomez, Malick Jammeh, Oley Bojang, Tida Jagne, Fatoumata Jallow, Adama Njie, Cherno S. Jallow, Mustapha Bittaye, Mariam Joof, Kebba S. Marenah, Yohana C. Sanchez, Maguette Mbaye, Nantenin Doumbia, Sabina Kangakan, Pokua Sarpong, Mhd A. Alkhateeb, Eduardo R. Cobas, Lamin Janneh, John D. Rolston, and John N. Jabang.
“We present a case of CC performed in The Gambia as part of an emerging epilepsy surgery program, focusing on the feasibility, the multidisciplinary coordination, and the perioperative considerations necessary in a resource-limited setting. This case aims to share insights and specific practice with global epilepsy community on initiating surgical epilepsy care in environments where such interventions are newly being established.” Gal et al., 2026
He experienced his first seizures at just ten months of age. As he grew older, they became more frequent and more severe. By the time he was referred to neurosurgeons, he was having up to ten falls a day. Antiseizure medications failed to control the most dangerous part of his condition. “Despite optimized and adequately trialed therapy with carbamazepine and sodium valproate, he continued to experience disabling seizures, leading to recurrent head trauma,” the authors explianed.
“Developmentally, the patient had significant delays in expressive language and had received no formal education. He was nonverbal at baseline and had not attended school prior to surgery, owing mainly to the frequency of his seizures, safety concerns from drop attacks, and limited access to specialized educational resources…The patient’s case was discussed in a multidisciplinary discussion involving local neurosurgery and neurology teams, anesthesia providers, and international epilepsy surgery collaborators.”
His mother took on the role of constant caregiver, which was necessary given the frequency and risk of injury associated with his falls. When the boy was evaluated at Edward Francis Small Teaching Hospital in The Gambia, doctors found clear signs of years of uncontrolled seizures: chronic injuries, calcified hematomas, and repeated trauma to the head.
The medical team decided to perform a corpus callosotomy
This procedure does not remove the source of epilepsy. Instead, it disconnects the main pathway between the left and right hemispheres of the brain, a structure known as the corpus callosum. The aim is to prevent the spread of seizure activity, particularly in seizures that lead to sudden falls.
“Epilepsy affects over 50 million people worldwide, with the majority residing in low- and middle-income countries (LMICs) where access to specialized care is often constrained…Moreover, studies from high-income countries indicate that up to one-third of individuals with epilepsy develop drug-resistant disease….Globally, it is estimated that more than 10 million patients with epilepsy may benefit from surgical intervention, with the greatest proportion of potential surgical candidates in LMICs, particularly in Africa and Latin America.” Gal et al., 2026
For years, The Gambia has faced a shortage of neurologists, neurosurgeons, and diagnostic equipment. Stigma has also been a major challenge, with epilepsy often linked to spiritual causes, influencing how and where people seek care. Corpus callosotomy does not require the most advanced technology. It depends on skilled surgeons, basic neurosurgical equipment, anesthesia support, and proper postoperative care. International collaboration played an important role in planning the procedure and supporting the development of local expertise.
The outcome for the boy was significant
After surgery, he no longer experienced drop attacks. For a child who had previously fallen up to ten times a day, this marked a dramatic change. Generalized tonic-clonic seizures occurred only during periods when, due to financial difficulties, he was unable to take his medication consistently.
“Postoperative MRI was not obtained due to the prohibitive out-of-pocket cost…From a family perspective, the pathway to surgery involved repeated healthcare visits, time away from work and home responsibilities for caregivers, and challenges with medication adherence, often disrupted by financial constraints.” Gal et al., 2026
This case shows that while surgery did not eliminate epilepsy, it removed its most dangerous manifestation. At the same time, it highlights a central challenge in managing epilepsy in resource-limited settings: ensuring that effective treatments are consistently available to those who need them. “Expansion to more patients will require continued investment in neurosurgical capacity, epilepsy care pathways, and longitudinal follow-up systems…Ongoing efforts within this international collaboration are focused on prospective patient enrollment, standardized seizure outcome reporting, and incorporating quality-of-life metrics as program capacity and follow-up infrastructure mature. Future efforts within this collaboration aim to establish prospective case series and, where feasible, a local epilepsy registry to enable systematic outcome tracking and guide program development,” they concluded.
Image: Understanding the Basics of Epilepsy | South Texas Health System
