Early hemispherectomy in catastrophic epilepsy: a neuro-cognitive and epileptic long-term follow-up
D Lettori1, D Battaglia, A Sacco
1Child Neurology and Psychiatry, Catholic University, Rome, Italy.
Insights
Early hemispherectomy surgery in children with catastrophic epilepsy improved seizure control and maintained neuro-cognitive development. This suggests earlier intervention may lead to better long-term outcomes for pediatric epilepsy patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Catastrophic epilepsy in early childhood significantly impacts neuro-cognitive development.
- Hemispherectomy is a surgical option for intractable epilepsy but long-term outcomes require further investigation.
Purpose of the Study:
- To evaluate the long-term neuro-cognitive and epileptic outcomes of hemispherectomy in children under five.
- To assess the impact of early surgical intervention on developmental trajectories.
Main Methods:
- Longitudinal study of 19 children with drug-resistant epilepsy undergoing hemispherectomy before age five.
- Pre- and post-operative assessments included clinical examination, neuroimaging, and prolonged scalp video-electroencephalography (EEG).
- Follow-up averaged 6 years and 6 months.
Main Results:
- Seventy-three point seven percent of patients achieved a seizure-free outcome.
- Gross motor skills generally improved, and cognitive abilities did not decline; two patients showed evident cognitive progress.
- Outcomes were less favorable in cases of cortical dysplasia compared to vascular cerebropathies.
Conclusions:
- Early hemispherectomy in young children with catastrophic epilepsy yields excellent seizure control and prevents developmental deterioration.
- Results suggest that earlier surgical treatment may offer superior long-term evolution compared to later interventions.
- Further research with larger cohorts is necessary to confirm the benefits of early hemispherectomy.
Abstract:
The authors report their experience about a neuro-cognitive and epileptic long-term follow-up of children with catastrophic epilepsy treated with hemispherectomy in the first 5 years of life. Nineteen children with resistant epilepsy that significantly interfered with their neuro-cognitive development underwent hemispherectomy within 5 years of life (mean: 2 years, 3 months; range: 5 months to 5 years). All patients were assessed before surgery and after, at least at the end of the follow-up (mean: 6 years and 6 months; range: 2-11 years and 2 months) with a full clinical examination including motor ability and functional status evaluation as well as behaviour observation, neuroimaging and an ictal/interictal prolonged scalp video-EEG. A seizure-free outcome was obtained in 73.7% of patients. Gross motility generally improved and cognitive competence did not worsen, with an evident progress in two cases. Consistently with previous reports, evolution was worse in cortical dysplasia than in progressive or acquired vascular cerebropathies. The excellent epileptic outcome and the lack of developmental deterioration in comparison with other more aged series seem to suggest a possible better evolution in earlier surgery treatment. To confirm this suggestion, however, further experience with larger series is needed.
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