Long-term functional outcomes and their predictors after hemispherectomy in 115 children
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Updated: May 8, 2026
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Published on: April 12, 2024
Ahsan N V Moosa1, Lara Jehi, Ahmad Marashly
1Department of Neurology, Section of Pediatric Epilepsy, Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Insights
Hemispherectomy in children leads to good ambulation but frequent language and reading impairments. Seizure recurrence and MRI findings predict poor outcomes, guiding presurgical counseling and interventions.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Neuroscience
Background:
- Hemispherectomy is a surgical procedure for intractable epilepsy in children.
- Long-term functional outcomes and predictors after hemispherectomy require comprehensive evaluation.
Purpose of the Study:
- To assess long-term functional outcomes (ambulation, vision, language, reading, behavior) in children post-hemispherectomy.
- To identify predictors of functional outcomes using a patient/family-centered approach.
Main Methods:
- Retrospective review of 186 children undergoing hemispherectomy (1997-2009).
- Collection of preoperative clinical, EEG, imaging, and surgical data.
- Structured questionnaires administered to 125 families to assess functional status and seizure outcomes; multivariate regression analysis used for predictor identification.
Main Results:
- At mean 6.05-year follow-up, 56% were seizure-free; 83% achieved independent ambulation.
- 70% had satisfactory spoken language, but only 42% of older children had satisfactory reading skills; 27% reported significant behavioral problems.
- Seizure recurrence, contralateral hemisphere MRI abnormalities, and preoperative quadriparesis independently predicted poor functional outcomes across domains.
Conclusions:
- Most hemispherectomy patients achieve independent ambulation, but significant challenges persist in reading and spoken language.
- Seizure recurrence and contralateral hemisphere abnormalities are key predictors of poorer functional outcomes.
- Findings aid in presurgical counseling and planning early interventions to optimize functional recovery post-hemispherectomy.
Purpose:
To examine the long-term functional outcomes and their predictors using a patient/family centered approach in a cohort of children who had hemispherectomy. Functional outcome measures studied were the following: ambulation ability, visual symptoms, spoken language, reading skills, and behavioral problems.
Methods:
We reviewed 186 consecutive children who underwent hemispherectomy between 1997 and 2009 at our center. Preoperative clinical, electroencephalography (EEG), imaging, and surgical data were collected. One hundred twenty-five families completed a structured questionnaire to assess the functional status and seizure outcome. Prognostic predictors were examined using a multivariate regression analysis.
Key Findings:
At a mean follow-up of 6.05 years after hemispherectomy, 70 patients (56%) were seizure-free and 45 (36%) had seizure recurrence; 10 patients (8%) were free of their preoperative seizures but had new-onset nonepileptic spells and were excluded from further analysis. Of 115, at follow-up (mean age at follow-up 12.7 years, range 2-28 years), 96 patients (83%) walked independently, 10 (8.7%) walked with assistance, and 9 (7.8%) were unable to walk. New visual symptoms that were not present preoperatively were reported only in 28 patients (24%). Eighty patients (70%) had satisfactory spoken language skills but only 44 (42%) of the 105 children older than 6 years had satisfactory reading skills. Significant behavioral problems were reported in 30 patients (27%). Only five (6.2%) of the 81 children aged between 6 and 18 years attended mainstream school without assistance; 48 (59%) were in mainstream school with assistance and the rest were in special school for disabled or home cared. Five (21%) of the 24 patients older than 18 years of age were gainfully employed. Multivariate logistic regression analysis identified the following factors as independently associated with poor functional outcome. (1) Seizure recurrence negatively affected all functional domains--ambulation ability, spoken language and reading skills, and behavior (p < 0.05). (2) Abnormalities in the unoperated hemisphere on magnetic resonance imaging (MRI) (p < 0.05) and preexisting quadriparesis (p < 0.01) correlated with poor motor outcome. (3) Multilobar MRI abnormalities in the contralateral hemisphere (odds ratio [OR] = 13.9, p = 0.001) and young age (indeterminate preoperative language status) at hemispherectomy (OR = 11.1, p = 0.01) also correlated with poor language outcome. (4) Younger age at epilepsy onset correlated with poor reading skills (p = 0.01) but not with spoken language skills.
Significance:
This study highlights the long-term functional status of patients after hemispherectomy. The majority of patients were ambulant independently; however, impairments in reading and spoken language were frequent. Seizure recurrence after hemispherectomy and contralateral hemisphere abnormalities on MRI were the major predictors of poor outcome in ambulation, spoken language, and reading abilities. This study will assist in presurgical counseling using simple understandable functional outcome measures and may help in planning early interventions after hemispherectomy to improve functional outcome.
