Hemispherectomy for intractable unihemispheric epilepsy etiology vs outcome

Area of Science:

• Neurosurgery
• Epileptology
• Pediatric Neurology

Background:

• Hemidecortication (surgical removal of one hemisphere) has been used for decades to manage intractable unihemispheric epilepsy.
• Previous studies documented outcomes from 58 surgeries; this review updates findings with an additional 53 cases.

Purpose of the Study:

• To update the long-term outcomes of hemidecortication for treating intractable unihemispheric epilepsy.
• To analyze the impact of etiology on seizure control and functional recovery.

Main Methods:

• A retrospective review of 111 patients who underwent hemidecortication between 1975 and 2001.
• Patient charts were reviewed, and families were contacted for follow-up data ranging from 3 months to 22 years.

Main Results:

• Overall, 65% of patients achieved seizure freedom, 21% had occasional seizures, and 14% experienced troublesome seizures.
• Functional outcomes were positive, with 89% walking unaided and 80% on minimal or no anticonvulsants.
• Etiology significantly impacted seizure control; patients with migrational disorders had lower seizure-free rates (51%) compared to other etiologies (71%, p=0.05).

Conclusions:

• Hemidecortication remains an effective procedure for reducing seizure frequency in unilateral cortical epilepsy.
• Migrational disorders represent a specific etiology associated with less favorable seizure outcomes post-hemidecortication.