Pediatric hemispherectomy outcome: Adaptive functioning, intelligence, and memory

BACKGROUND Rasmussen encephalitis is a rare chronic neurological pathology frequently treated with functional hemispherectomy (or hemispherotomy). This surgical procedure frees patients of their severe epilepsy associated with the disease but may induce cognitive disorders and notably language alterations after disconnection of the left hemisphere. OBSERVATIONS The authors describe longitudinally 3 cases of female patients with Rasmussen encephalitis who underwent left hemispherotomy in childhood and benefited from a favorable cognitive outcome. In the first patient, the hemispherotomy occurred at a young age, and the recovery of language and cognitive abilities was rapid and efficient. The second patient benefited from the surgery later in childhood. In addition, she presented a reorganization of language and memory functions that seem to have been at the expense of nonverbal ones. The third patient was a teenager during surgery. She benefited from a more partial cognitive recovery with persistent disorders several years after the surgery. LESSONS Recovery of cognitive functions, including language, occurs after left hemispherotomy, even when performed late in childhood. Therefore, the surgery should be considered as early as possible to promote intercognitive reorganization.

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“… 32 , 33 Indeed, after hemispherotomy, better recovery of verbal functions has been demonstrated with a priority for language and memory. 34 …”

Section: Discussionmentioning

confidence: 99%

“…32,33 Indeed, after hemispherotomy, better recovery of verbal functions has been demonstrated with a priority for language and memory. 34 The case reports highlight a variety of cognitive recovery trajectories. Indeed, a better outcome was observed for patient 1 with good verbal and nonverbal abilities in adulthood.…”

Section: Observationsmentioning

confidence: 99%

Cognitive outcome after left functional hemispherectomy on dominant hemisphere in patients with Rasmussen encephalitis: beyond the myth of aphasia. Patient series

Borne

Perrone‐Bertolotti

Jambaqué

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…Ideal candidates for hemispheric surgery have DRE related to a hemispheric syndrome with contralateral neurological deficits 1,3,6,12,13 and have concordant presurgical test results 1,3,6 with expected postoperative stability or improvement of neurological impairment (e.g., language), cognition, and adaptive functioning. 14 Some studies have reported positive outcomes despite putative negative prognostic factors, such as bilateral electroencephalography (EEG) or magnetic resonance imaging (MRI) findings. 5,6,12,15,16 Overall, benefits of this surgery often outweigh the risks, even for non-ideal candidates.…”

Section: Introductionmentioning

confidence: 99%

Development of an online calculator for the prediction of seizure freedom following pediatric hemispherectomy using the Hemispherectomy Outcome Prediction Scale (HOPS)

Weil

Dimentberg

Lewis³

et al. 2023

Epilepsia

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ObjectivesAlthough hemispheric surgeries are among the most effective procedures for drug‐resistant epilepsy (DRE) in the pediatric population, a large variability in outcomes remains. Identifying ideal hemispherectomy candidates is imperative to maximize the potential for seizure freedom. The objective was to develop an online, freely‐accesible tool that accurately predicts the probability of seizure freedom for any patient at 1‐, 2‐, and 5‐years post‐hemispherectomy to provide clinicians accessible and reliable prognostic information to complement clinical judgement.MethodsRetrospective data of all pediatric patients with DRE and seizure outcome data from the original Hemispherectomy Outcome Prediction Scale (HOPS) study were included. The primary outcome of interest was time‐to‐seizure recurrence. A multivariate Cox proportional‐hazards regression model was developed to predict the likelihood of post‐hemispheric surgery seizure freedom duration based on a combination of variables identified by clinical judgement and inferential statistics as predictive of the primary outcome. The final model from this study was encoded in a publicly accessible online calculator on the (iNEST) website.ResultsThe selected variables for inclusion in the final model included the 5 original HOPS variables (age at seizure onset, etiologic substrate, seizure semiology, prior non‐hemispheric resective surgery, and contralateral FDG‐PET hypometabolism) and 3 additional variables (age at surgery, history of infantile spasms, and magnetic resonance (MR) imaging lesion). Predictors of shorter time‐to‐seizure recurrence included younger age at seizure onset, older age at surgery, prior resective surgery, generalized seizure semiology, FDG‐PET hypometabolism contralateral to side of surgery, contralateral MR imaging lesion, non‐lesional MR imaging, non‐stroke etiologies, and history of infantile spasms. The area under the curve (AUC) of the final model was 73.0%.SignificanceOnline calculators are efficient, cost‐free tools that can facilitate physicians in risk‐estimation and inform joint decision‐making with families, potentially leading to greater satisfaction. Although the HOPS data was previously validated in the first analysis, the authors encourage prospective external validation of this new tool.

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“…A grande parcela de pacientes com DI moderada a grave no preOP, o aumento dos quadros comportamentais e do uso de medicação psicotrópica no PO podem ter contribuído para a piora desse domínio. Essas relações não foram tão detalhadas em outros estudos (HUM et al, 2010;MOOSA et al, 2013;PUKA;SMITH, 2015;PULSIFER et al, 2004;van SCHOONEVELD et al, 2016;ZUPANC et al, 2010) LEE et al, 2014;PANIGRAHI et al, 2016;PULSIFER et al, 2004;SHURTLEFF et al, 2021;van SCHOONEVELD et al 2016;VILLAREJO-ORTEGA et al, 2013). Em crianças com grave comprometimento cognitivo, melhorias na NPS, de forma geral, podem ser melhor avaliadas em um período longo de seguimento de cinco a mais anos (SKIRROW et al, 2011).…”

Section: Discussionunclassified

“…A maioria dos estudos demonstrou que o desenvolvimento e a cognição não são muito afetados após a cirurgia, permanecendo inalterados na maioria das vezes, apesar da melhora na QV das crianças (DUCHOWNY et al, 1998;PULSIFER et al, 2004;SABAZ et al, 2006;SHURTLEFF et al, 2021;van SCHOONEVELD et al, 2016;VILLAREJO-ORTEGA et al, 2013;VINING et al, 1997). Fatores como curto período entre o início da epilepsia e a cirurgia, controle de crises após a cirurgia, além de maiores coeficientes de desenvolvimento no preOP, influenciam positivamente no desenvolvimento e desfecho neurológico (JONAS et al, 2005).…”

Section: Desfechos Clínicos Da Hemisferotomiaunclassified

Análise pós-cirúrgica da qualidade de vida e sobrecarga do cuidador de crianças e adolescentes submetidos à hemisferotomia para tratamento da epilepsia farmacorresistente

Daniel¹

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Pediatric hemispherectomy outcome: Adaptive functioning, intelligence, and memory

Cited by 8 publications

References 37 publications

Cognitive outcome after left functional hemispherectomy on dominant hemisphere in patients with Rasmussen encephalitis: beyond the myth of aphasia. Patient series

Cognitive outcome after left functional hemispherectomy on dominant hemisphere in patients with Rasmussen encephalitis: beyond the myth of aphasia. Patient series

Development of an online calculator for the prediction of seizure freedom following pediatric hemispherectomy using the Hemispherectomy Outcome Prediction Scale (HOPS)

Análise pós-cirúrgica da qualidade de vida e sobrecarga do cuidador de crianças e adolescentes submetidos à hemisferotomia para tratamento da epilepsia farmacorresistente

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