Hemispherectomy: a basis for mental development in children with epilepsy.
Monique M J van Schooneveld1, Aag Jennekens-Schinkel, Peter C van Rijen
1Department of Paediatric Psychology, Sector of Neuropsychology, Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands. M.vanSchooneveld-2@umcutrecht.nl
Summary
Hemispherectomy surgery can help children with intractable epilepsy to improve mental development. Despite presurgical decline, cognitive function can progress after hemisphere removal.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
Background:
- Pharmacologically intractable epilepsy significantly impacts cognitive development in children.
- Pre-surgical cognitive decline is common in children with severe epilepsy requiring hemispherectomy.
Purpose of the Study:
- To evaluate changes in mental development and intelligence in children two years after hemispherectomy.
- To assess the long-term cognitive outcomes of hemispherectomy in pediatric epilepsy patients.
Main Methods:
- Prospective study with consecutive inclusion of pediatric patients undergoing hemispherectomy.
- Assessment of mental developmental index (MDI), mental age (MA), and intelligence quotient (IQ) at baseline and 24 months post-surgery.
- Inclusion of both infants/preschoolers and older children with intractable seizures.
Main Results:
- Mental development arrested or deteriorated in 82% of younger children before surgery.
- Mental age (MA) increased in 16 children post-hemispherectomy.
- Intelligence quotient (IQ) showed negligible overall change, but individual variability was noted; children with Rasmussen encephalitis did not recover pre-surgical intelligence decline.
Conclusions:
- Hemispherectomy can facilitate further mental development in epileptic children, even those with severe pre-existing delays.
- The procedure offers a pathway for cognitive improvement by removing the affected hemisphere, despite potential presurgical deterioration.
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