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Hemispherectomy for catastrophic epilepsy in infants
Jorge A González-Martínez1, Ajay Gupta, Prakash Kotagal
1Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gonzalj1@ccf.org
Epilepsia
|September 9, 2005
Summary
Hemispherectomy offers excellent seizure control for young children with catastrophic epilepsy. Early surgical intervention by an expert team is crucial for successful outcomes and improved quality of life.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Pediatric Neurology
Background:
- Catastrophic epilepsy in children under two years presents significant challenges.
- Refractory epilepsy necessitates aggressive treatment strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of hemispherectomy in treating catastrophic epilepsy in infants.
- To identify factors influencing seizure outcomes post-hemispherectomy.
Main Methods:
- Retrospective analysis of 18 patients (22 procedures) undergoing various hemispherectomy techniques.
- Pre- and postoperative assessments included video-EEG, MRI, and PET scans.
- Statistical analysis using Generalized Estimation Equation (GEE) and Barnard's exact test.
Main Results:
- 66% of patients achieved seizure freedom; 27% had >90% seizure reduction.
- Overall complication rate was 16.7% with no deaths.
- Incomplete surgical disconnection was the only factor significantly associated with persistent seizures (p<0.05).
Conclusions:
- Hemispherectomy provides excellent seizure control with a satisfactory complication rate in young children.
- Early surgical intervention is recommended for highly selected pediatric patients with catastrophic epilepsy.
- Mandatory safety factors include an expert pediatric intensive care unit team, neuroanesthesia, and a skilled pediatric epilepsy surgeon.