Seizure and developmental outcomes after hemispherectomy in children and adolescents with intractable epilepsy

Villarejo-Ortega, Francisco; García-Fernández, María; Castillo, Concepción Fournier-Del; Fabregate-Fuente, Martín; Álvarez‐Linera, Juan; Prada-Vicente, Inmaculada de; Budke, Marcelo; Ruiz-Falcó, M.L.; Pérez-Jiménez, M.A.

doi:10.1007/s00381-012-1949-8

Cited by 42 publications

(33 citation statements)

References 40 publications

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“…Some previous studies have found that seizure outcomes differ significantly with the underlying etiology, and that they are significantly worse in epilepsy patients with a developmental pathology than in those with an acquired pathology 7,11,16,17. In contrast, another study found no correlation between seizure outcome and etiology 12.…”

Section: Discussionmentioning

confidence: 89%

Long-Term Outcomes of Hemispheric Disconnection in Pediatric Patients with Intractable Epilepsy

et al. 2014

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Background and PurposeHemispherectomy reportedly produces remarkable results in terms of seizure outcome and quality of life for medically intractable hemispheric epilepsy in children. We reviewed the neuroradiologic findings, pathologic findings, epilepsy characteristics, and clinical long-term outcomes in pediatric patients following a hemispheric disconnection.MethodsWe retrospectively studied 12 children (8 males) who underwent a hemispherectomy at Asan Medical Center between 1997 and 2005. Clinical, EEG, neuroradiological, and surgical data were collected. Long-term outcomes for seizure, motor functions, and cognitive functions were evaluated at a mean follow-up of 12.7 years (range, 7.6-16.2 years) after surgery.ResultsThe mean age at epilepsy onset was 3.0 years (range, 0-7.6 years). The following epilepsy syndromes were identified in our cohort: focal symptomatic epilepsy (n=8), West syndrome (n=3), and Rasmussen's syndrome (n=1). Postoperative histopathology of our study patients revealed malformation of cortical development (n=7), encephalomalacia as a sequela of infarction or trauma (n=3), Sturge-Weber syndrome (n=1), and Rasmussen's encephalitis (n=1). The mean age at surgery was 6.5 years (range, 0.8-12.3 years). Anatomical or functional hemispherectomy was performed in 8 patients, and hemispherotomy was performed in 4 patients. Eight of our 12 children (66.7%) were seizure-free, but 3 patients with perioperative complications showed persistent seizure. Although all patients had preoperative hemiparesis and developmental delay, none had additional motor or cognitive deficits after surgery, and most achieved independent walking and improvement in daily activities.ConclusionsThe long-term clinical outcomes of hemispherectomy in children with intractable hemispheric epilepsy are good when careful patient selection and skilled surgical approaches are applied.

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Section: Discussionmentioning

confidence: 89%

Long-Term Outcomes of Hemispheric Disconnection in Pediatric Patients with Intractable Epilepsy

et al. 2014

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“…Furthermore, a better outcome after surgery can be expected in patients operated on at a younger age and with a shorter duration of epilepsy [9]. Most studies have reported on seizure outcome after specific surgical procedures, such as temporal lobe resection [10,11] or hemispherectomy [12][13][14]. As clinicians, we meet children with medically intractable epilepsy and intellectual disabilities, but there are relatively few studies describing the cognitive outcome in unselected children with epilepsy severe enough to justify neurosurgery of any type, especially for the subgroup of children with a low IQ [6,9,15].…”

Section: Introductionmentioning

confidence: 99%

Intelligence two years after epilepsy surgery in children

Viggedal

Olssøn

Carlsson

et al. 2013

Epilepsy & Behavior

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Intelligence before and two years after epilepsy surgery was assessed in 94 children and adolescents and related to preoperative IQ and seizure outcome. The median full-scale IQ was 70 before and two years after surgery. The proportion with a higher or unchanged postoperative IQ was 24 of 49 (49%) of those with an IQ of 70 and more before surgery, nine of 17 (53%) of those with an IQ of 50-69, and ten of 28 (36%) of those with an IQ of less than 50. A significant difference was found between the 47 individuals who became seizure-free and the 47 with persisting seizures, as 60% of the seizure-free children had a higher or unchanged IQ compared with 32% of the 47 who were not seizure-free. The cognitive outcome of children with intellectual disabilities was as good as that of children with average IQ. Thus, they should not be excluded from epilepsy surgery on the basis of low intellectual level.

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“…2,3,5,8,9,[17][18][19] We used data from the Nationwide Inpatient Sample (NIS) from 1988 to 2010 to extrapolate the national rate of hemispherectomy procedures over time and patient and hospital characteristics associated with in-hospital complications for patients undergoing these procedures to treat medically intractable epilepsy. To the authors' knowledge, this is the largest study to date evaluating trends in hemispherectomy performance and associated in-hospital complications.…”

mentioning

confidence: 99%

National Trends and In-hospital Complication Rates in More Than 1600 Hemispherectomies From 1988 to 2010

et al. 2015

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Seizure and developmental outcomes after hemispherectomy in children and adolescents with intractable epilepsy

Cited by 42 publications

References 40 publications

Long-Term Outcomes of Hemispheric Disconnection in Pediatric Patients with Intractable Epilepsy

Long-Term Outcomes of Hemispheric Disconnection in Pediatric Patients with Intractable Epilepsy

Intelligence two years after epilepsy surgery in children

National Trends and In-hospital Complication Rates in More Than 1600 Hemispherectomies From 1988 to 2010

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