Functional consequences of hemispherectomy.

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Rehabilitation Medicine

Background:

• Hemispherectomy is a surgical option for severe pediatric epilepsy.
• Understanding the long-term functional outcomes post-hemispherectomy is crucial for patient management.
• The International Classification of Functioning, Disability and Health (ICF) provides a framework for assessing outcomes.

Purpose of the Study:

• To evaluate the impact of hemispherectomy on impairments, activities, and social participation in children.
• To assess changes in seizure control, motor function, self-care, mobility, and social function over a 2-year period.
• To quantify epilepsy-related restrictions using validated scales.

Main Methods:

• Longitudinal study of 12 children (mean age 5.9 years) before and up to 2 years after hemispherectomy.
• Assessment of impairments: seizure frequency (Engel), seizure severity (HASS), muscle strength (MRC), range of motion (JAM), muscle tone (modified Ashworth).
• Assessment of activities: gross motor functioning (GMFM), PEDI (self-care, mobility, social function).
• Assessment of participation: epilepsy-related restrictions (HARCES).

Main Results:

• 9/12 children achieved seizure freedom (Engel class I); 3/12 had Engel class III.
• Significant improvements in seizure severity (HASS), gross motor functioning (GMFM: +20%), and PEDI scores (+20 scale points) were observed.
• Motor impairments (strength, tone) showed temporary decline post-surgery but returned to baseline; range of motion remained impaired.
• Epilepsy-related restrictions (HARCES) normalized in most children within 2 years.

Conclusions:

• Decreased seizure frequency and severity following hemispherectomy significantly enhance motor and social functioning.
• Functional improvements in activities and participation can override residual motor impairments.
• Hemispherectomy can lead to substantial gains in quality of life for children with severe epilepsy.