Contralateral MRI abnormalities in candidates for hemispherectomy for refractory epilepsy.
Tove Hallbook1, Paul Ruggieri, Chirla Adina
1Department of Neurology, Cleveland Clinic, Children's Hospital, Cleveland, Ohio, USA. Tove.Hallbook@telia.com
Epilepsia
|October 13, 2009
Summary
Contralateral magnetic resonance imaging (MRI) abnormalities are common in children undergoing hemispherectomy for refractory epilepsy but do not impact seizure outcomes. These findings, typically mild, should not contraindicate surgery in suitable candidates.
Area of Science:
- Neurology
- Pediatric Epilepsy Surgery
- Neuroradiology
Background:
- Refractory epilepsy in children often necessitates hemispherectomy.
- Contralateral magnetic resonance imaging (MRI) findings are frequently observed but their impact on surgical outcomes is debated.
Purpose of the Study:
- To evaluate the influence of contralateral MRI abnormalities on seizure control following hemispherectomy in pediatric patients with refractory epilepsy.
Main Methods:
- Retrospective review of 110 children (0.4-18 years) who underwent hemispherectomy for severe refractory epilepsy.
- Analysis of preoperative MRI findings, including ipsilateral and contralateral abnormalities, and their correlation with seizure outcomes.
Main Results:
- Contralateral MRI abnormalities were present in 74% of patients, particularly those with congenital or early acquired etiologies.
- Seizure-free rates were similar (79% vs. 83%) in patients with and without contralateral MRI findings.
- Etiology, type, or severity of contralateral abnormalities did not significantly affect seizure outcomes.
Conclusions:
- Mild to moderate contralateral MRI abnormalities are common in pediatric hemispherectomy candidates and do not predict seizure outcome.
- These findings should not preclude hemispherectomy in otherwise favorable candidates with refractory epilepsy.
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