[Functional hemispherectomy in adult patients with catastrophic epilepsy: a new therapeutic indication?]

Functional hemispherectomy was reported in 1983 for the treatment of catastrophic refractory epilepsies in order to reduce the complications derived by the anatomical hemispherectomy. A series of variants of the functional hemisphectomy have been reported. They include peri-insular hemispherectomy, modified lateral hemispherectomy, vertical parasagital hemispherectomy. The functional hemispherectomy has been used mainly in the treatment of catastrophic epilepsies in children, in which extensive hemispheric lesions are associated with pharmacoresistant epileptic seizures and focal neurological deficit such as: Rasmussen's encephalitis, hemimegalencephaly, Sturge-Weber syndrome, and extensive hemispheric cortical dysplasias, etc. Recently, two series of adults patients with catastrophic epilepsies with excellent control of the episodes (above 75 %) and without mortality have been reported. Thus, functional hemispherectomy may be an effective procedure in appropriately selected adult patients, although more studies with larger series are still needed to evaluate the long-term prognosis.