Contralateral MRI abnormalities affect seizure and cognitive outcome after hemispherectomy
K Boshuisen1, M M J van Schooneveld, F S S Leijten
1Rudolf Magnus Institute of Neuroscience, Department of Child Neurology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
Neurology
|November 3, 2010
Summary
Contralateral MRI abnormalities predict poor seizure control and cognitive outcomes after functional hemispherectomy in children. EEG abnormalities in the "healthy" hemisphere did not impact results.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Functional hemispherectomy is a surgical option for intractable epilepsy.
- Predictors of seizure control and cognitive outcome require further investigation.
Purpose of the Study:
- To determine if electroencephalogram (EEG) and magnetic resonance imaging (MRI) abnormalities in the non-affected hemisphere influence outcomes after functional hemispherectomy.
- To assess the impact of contralateral abnormalities on seizure status and cognitive development.
Main Methods:
- Retrospective cohort study of 43 children undergoing functional hemispherectomy (1994-2008).
- Preoperative EEG and MRI data were reviewed for contralateral abnormalities.
- Seizure freedom (Engel 1A) and cognitive scores (IQ/MDI) were assessed postoperatively.
Main Results:
- Seventy-seven percent of children achieved seizure freedom.
- Contralateral MRI abnormalities were associated with lower seizure freedom rates (45% vs 88%, p=0.030).
- Children with contralateral MRI abnormalities showed worse postoperative cognitive outcomes (90% vs 42% severe delay, p=0.030; no improvement in 100% vs 38%, p=0.034).
Conclusions:
- Unequivocal contralateral MRI abnormalities are linked to poor seizure control and cognitive development after hemispherectomy.
- Contralateral EEG abnormalities did not negatively affect surgical outcomes.
- Contralateral MRI lesions may be a relative contraindication for hemispherectomy.
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