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Updated: Mar 17, 2026
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Successful hemispherotomy for a patient with intractable epilepsy secondary to bilateral congenital brain
Yuri Nagai1, Ayataka Fujimoto1, Tohru Okanishi1
1Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
Insights
Drug-resistant epilepsy in a young boy with bilateral brain malformations was successfully treated with epilepsy surgery. A right hemispherotomy resulted in seizure freedom, demonstrating the efficacy of targeted surgical intervention.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Neuroimaging
Background:
- Congenital brain malformations can lead to drug-resistant epilepsy in children.
- Accurate presurgical evaluation is crucial for identifying surgical candidates.
- Bilateral abnormalities pose challenges in determining the epileptogenic zone.
Purpose of the Study:
- To describe the surgical management of a pediatric patient with drug-resistant epilepsy secondary to bilateral brain malformations.
- To evaluate the efficacy of right hemispherotomy in achieving seizure control.
Main Methods:
- Presurgical evaluation including Magnetic Resonance Imaging (MRI), Diffusion Tensor Image tractography (DTI), and electroencephalography (EEG).
- Surgical intervention: Right hemispherotomy.
- Long-term video-EEG monitoring for seizure assessment.
Main Results:
- MRI revealed bilateral polymicrogyria, right schizencephaly, and corpus callosum agenesis, with more severe abnormalities in the right hemisphere.
- DTI demonstrated a clear left pyramidal tract but an unclear right pyramidal tract, indicating laterality.
- Interictal and long-term video-EEG confirmed epileptiform discharges and habitual seizures originating from the right frontal area.
- Right hemispherotomy resulted in complete seizure freedom and reduced need for anti-epilepsy drugs.
Conclusions:
- Epilepsy surgery, specifically right hemispherotomy, can be highly effective in pediatric patients with drug-resistant epilepsy and bilateral brain malformations.
- DTI-based laterality assessment is valuable in surgical planning for complex epilepsy cases.
- Successful surgical outcomes can significantly improve quality of life by achieving seizure freedom.
Purpose:
To perform an epilepsy surgery on a patient with drug resistant epilepsy secondary to bilateral brain malformation. The patient was a 2-year 9-month-old boy who had congenital bilateral multiple abnormalities. He developed a complex partial seizure at 9 months old. Based on the presurgical evaluations, he underwent a right hemispherotomy.
Results:
Brain MRI revealed congenital bilateral polymicrogyria, right schizencephaly, and corpus callosum agenesis. The abnormality was noted to be more severe in the right hemisphere. Diffusion tensor image tractography clearly detected a left pyramidal tract. On the contrary, the right hemisphere did not show a clear pyramidal tract. An interictal EEG showed epileptiform discharges over both hemispheres with right frontotemporal area dominancy. The long-term video-EEG recorded his habitual seizures arising from the right frontal area. Right hemispherotomy led to freedom from seizures and a reduced need for anti-epilepsy drugs.
Conclusions:
We report a patient with bilateral MRI and EEG abnormalities with clear DTI laterality who achieved seizure freedom with epilepsy surgery.
