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01-12-2020 | Magnetic Resonance Imaging | Original Article

Multimodal assessment of motor pathways and intracortical connections in functional hemispherectomy

Authors: Fabio Pilato, Emanuele Pravatà, Domenica Battaglia, Rosalinda Calandrelli, Luca Massimi, Concezio Di Rocco, Vincenzo Di Lazzaro

Published in: Child's Nervous System | Issue 12/2020

Abstract

Purpose

For selected children with medically intractable epilepsy, hemispherectomy can be an excellent treatment option and its efficacy in achieving seizure freedom or reduction in seizure frequency has been shown in several studies, but patients’ selection could not be straightforward and often it is taken on subjective basis. We described a multimodal approach to assess patient eligible for hemispherectomy and possibly predicting post-surgical outcomes.

Methods

We describe pre- and post-surgical clinical features along with neuroradiological results by magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), MR-tractography (MRT), and neurophysiological study by single and paired pulses transcranial magnetic stimulation (TMS) in a child with cerebral palsy with epileptic encephalopathy, eligible for epilepsy surgery.

Results

Presurgical TMS evaluation showed a lateralization of motor function on the left motor cortex for both arms, and results were confirmed by MRI studies. Interestingly, after surgery, both epilepsy and motor performances improved and TMS showed enhancement of intracortical inhibition and facilitation activity.

Conclusion

Functional hemispherectomy is an effective treatment for drug-resistant epilepsy, and multimodal presurgical assessment may be a useful approach to guide surgeons in selecting patients. Moreover, pre- and post-surgical evaluation of these patients may enhance our understanding of brain plasticity phenomena.

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Title: Multimodal assessment of motor pathways and intracortical connections in functional hemispherectomy
Authors: Fabio Pilato
Emanuele Pravatà
Domenica Battaglia
Rosalinda Calandrelli
Luca Massimi
Concezio Di Rocco
Vincenzo Di Lazzaro
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Transcranial Magnetic Stimulation
Epilepsy
Transcranial Magnetic Stimulation
Published in: Child's Nervous System / Issue 12/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-020-04617-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Multimodal assessment of motor pathways and intracortical connections in functional hemispherectomy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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