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Parasagittal hemispherotomy in hemispheric polymicrogyria with electrical status epilepticus during slow sleep:

Martine Fohlen1, Georg Dorfmüller1, Sarah Ferrand-Sorbets1

  • 1Pediatric Neurosurgery Unit, Rothschild Foundation Hospital, 29 rue Manin, 75019, Paris, France.

Seizure
|August 7, 2019
PubMed
Abstract

Insights

Hemispherotomy surgery effectively treated drug-resistant electrical status epilepticus during slow sleep (ESESS) in children with hemispheric polymicrogyria (PMG), leading to seizure freedom and cognitive improvement.

Area of Science:

  • Pediatric Neurology
  • Neurosurgery
  • Epileptology

Background:

  • Polymicrogyria (PMG) is the most common brain malformation, but rarely requires epilepsy surgery.
  • Hemispheric PMG can lead to electrical status epilepticus during slow sleep (ESESS), causing neurological decline and drug resistance.

Purpose of the Study:

  • To evaluate the efficacy of hemispherotomy in children with drug-resistant ESESS and unilateral PMG.
  • To assess post-surgical outcomes, including seizure control, cognitive function, and motor status.

Main Methods:

  • Retrospective review of 18 children who underwent hemispherotomy for epilepsy due to unilateral PMG and drug-resistant ESESS.
  • Analysis of clinical data, electrophysiological findings, and long-term post-surgical outcomes.

Main Results:

  • All 18 patients experienced resolution of ESESS and 16 became seizure-free after a mean follow-up of 12.8 years.
  • Significant improvements in behavior and cognitive function were observed in all patients.
  • Preoperative developmental delay and hemiparesis were noted, with a risk of motor aggravation post-surgery.

Conclusions:

  • Hemispherotomy is a viable surgical option for drug-resistant ESESS in hemispheric PMG, offering seizure cessation and cognitive benefits.
  • While medical treatment may suffice in some cases, surgery provides definitive seizure control.
  • Potential risks, including motor function aggravation, should be considered alongside the benefits.
Keywords:
ChildrenElectrical status epilepticus during slow sleepHemispherotomyPolymicrogyria

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