Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients
Vera Cristina Terra-Bustamante1, Luciana Midori Inuzuka, Regina Maria França Fernandes
1Department of Neurology, Psychiatry and Psychology, Ribeirão Preto School of Medicine, University of São Paulo, CEP 14048-900 Ribeirão Preto, São Paulo, Brazil. vctbusta@mp.fmrp.usp.br
Insights
Hemispherectomy surgery for intractable pediatric epilepsy significantly reduces seizure frequency in most patients. While hemiparesis may worsen post-surgery, outcomes are generally favorable for those with unilateral brain lesions.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Epilepsy
Background:
- Hemispheric brain lesions are linked to severe early-onset epilepsies and multiple seizure types.
- Hemispherectomy is a surgical option for patients with unilateral intractable epilepsy.
- Recent advancements aim to improve hemispherectomy techniques, reducing surgical risks and complications.
Purpose of the Study:
- To evaluate the clinical characteristics, presurgical evaluation, and postsurgical outcomes of pediatric patients undergoing hemispherectomy.
- To assess the efficacy and safety of hemispherectomy for medically intractable epileptic seizures in children.
Main Methods:
- Retrospective analysis of 39 pediatric patients who underwent hemispherectomy between 1996 and 2005.
- Inclusion criteria: medically intractable epilepsy and unilateral hemispheric disease confirmed by video-EEG and MRI.
Main Results:
- 74.4% of patients were male. Common seizure types included tonic and focal motor seizures.
- Rasmussen encephalitis (30.8%) and cortical malformations (23.1%) were leading etiologies.
- 61.5% achieved Engel class I or II outcome; 89.5% had ≥90% seizure reduction. All patients experienced acute hemiparesis worsening.
Conclusions:
- Hemispherectomy can achieve significant seizure reduction in pediatric patients with unilateral intractable epilepsy.
- Despite expected neurological impairments like hemiparesis, the procedure offers a good surgical outcome for selected patients.
- Surgical techniques demonstrated similar efficacy, with one showing a trend towards complete disconnection.
Background:
Hemispheric brain lesions are commonly associated with early onset of catastrophic epilepsies and multiple seizure types. Hemispheric surgery is indicated for patients with unilateral intractable epilepsy. Although described more than 50 years ago, several new techniques for hemispherectomy have only recently been proposed aiming to reduce operatory risks and morbidity.
Materials And Methods:
We present the clinical characteristics, presurgical workup, and postoperative outcome of a series of pediatric patients who underwent hemispherectomy for medically intractable epileptic seizures. Thirty-nine patients with medically intractable epilepsy underwent surgery from 1996 to 2005.
Results And Discussion:
We analyzed demographic data, interictal and ictal EEG findings, age at surgery, surgical technique and complications, and postsurgical seizure outcome. There were 74.4% males. Tonic and focal motor seizures occurred in 30.8 and 20.5% of the patients. Most frequent etiologies were Rasmussen encephalitis (30.8%) and malformation of cortical development (23.1%). Postsurgical outcomes were Engel classes I and II for 61.5% of the patients. In general, 89.5% of the patients exhibited at least a 90% reduction in seizure frequency. All patients had acute worsening of hemiparesis after surgery. Basically, two surgical techniques have been employed, both with similar results, although a trend has been noted toward one of the procedures which produced consistently complete disconnection. Patients with hemispheric brain lesions usually have abnormal neurological development and intractable epilepsy. When video-EEG monitoring and magnetic resonance imaging show unilateral disease, the patient may evolve with a good surgical outcome. We showed that a marked reduction in seizure frequency may be achieved, with acceptable neurological impairments.
