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Child's Nervous System
Published in: Child's Nervous System 3/2013

01-03-2013 | Original Paper

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

Authors: Francisco Villarejo-Ortega, Marta García-Fernández, Concepción Fournier-Del Castillo, Martín Fabregate-Fuente, Juan Álvarez-Linera, Inmaculada De Prada-Vicente, Marcelo Budke, María-Luz Ruiz-Falcó, María-Ángeles Pérez-Jiménez

Published in: Child's Nervous System | Issue 3/2013

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Abstract

Purpose

The aim of this study is to describe a series of pediatric hemispherectomies, reviewing pathologic substrate, epilepsy characteristics and seizure outcome as well as developmental profiles, before and after surgery, in different domains.

Methods

Seventeen patients with full pre-surgical work-up, minimum follow-up of 12 months, and at least one post-surgical neuropsychological evaluation were selected. Three had Rasmussen encephalitis (RE), five hemispheric malformations of cortical development (MCD), and nine hemispheric vascular lesions.

Results

At latest follow-up, all patients with RE and 66.7 % of those with vascular lesions are in Engel’s class I; in the latter group, pre-surgical independent contralateral EEG discharges statistically correlated with a worse seizure outcome. Patients with MCD showed the worst seizure outcome. Pre-surgical language transfer to the right hemisphere was confirmed in a boy with left RE, operated on at 6 years of age. Patients with MCD and vascular lesions already showed severe global developmental delay before surgery, which persists afterwards. A linear correlation was found between earlier age at surgery and better outcome in personal–social, gross motor, and adaptive domains, in the vascular lesions group. The case with highest cognitive improvement had continuous spike and wave during sleep on pre-surgical EEG.

Conclusions

Pathologic substrate was the main factor related with seizure outcome. In children with MCD and vascular lesions, although developmental progression is apparent, significant post-surgical improvements are restricted by the severity of pre-surgical neuropsychological disturbances and a slow maturation. Early surgery assessment is recommended to enhance the possibilities for a better quality of life in terms of seizure control, as well as better autonomy and socialization.
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Metadata
Title
Seizure and developmental outcomes after hemispherectomy in children and adolescents with intractable epilepsy
Authors
Francisco Villarejo-Ortega
Marta García-Fernández
Concepción Fournier-Del Castillo
Martín Fabregate-Fuente
Juan Álvarez-Linera
Inmaculada De Prada-Vicente
Marcelo Budke
María-Luz Ruiz-Falcó
María-Ángeles Pérez-Jiménez
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 3/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-012-1949-8

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