Functional hemispherectomy: EEG findings, spiking from isolated brain postoperatively, and prediction of outcome

We reviewed the prognostic significance of preoperative EEG findings in 25 patients who underwent functional hemispherectomy. Bilateral independent epileptogenic foci, found in five patients, generally indicate a less satisfactory outcome, with only three of the five patients becoming seizure free following hemispherectomy. In contrast, abnormalities of background activity over the "good" hemisphere, multifocal epileptic activity confined to the side of operation, or bilaterally synchronous discharges were associated with a good outcome and should not be considered as contraindications to operation. Postoperatively, discharges may occur in the functionally isolated frontal and occipital cortex, which are benign, with no other clinical significance than showing that the isolated cortex remains viable and continues to generate epileptogenic potentials.