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Epilepsy surgery for Rasmussen encephalitis: the UCLA experience.

Nikhil Bellamkonda¹, H Westley Phillips¹, Jia-Shu Chen^1,2

¹Departments of1Neurosurgery.

Journal of Neurosurgery. Pediatrics

|July 18, 2020

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Epilepsy surgery for Rasmussen encephalitis (RE) offers seizure control but not a cure. Anatomical hemispherectomy may delay seizure recurrence, suggesting palliative rather than curative treatment for this rare neurological disorder.

Area of Science:

Neurology
Neurosurgery
Pediatric Neurology

Background:

Rasmussen encephalitis (RE) is a rare, unilateral inflammatory neurological disorder.
It leads to drug-resistant epilepsy and progressive neurological decline.
Epilepsy surgery is a treatment option for RE.

Purpose of the Study:

To evaluate seizure outcomes in children undergoing epilepsy surgery for RE.
To analyze the long-term efficacy of different surgical approaches.

Main Methods:

Retrospective review of 44 pediatric patients with RE undergoing epilepsy surgery (1982-2018).
Analysis of demographic data, seizure history, surgical procedures, and postoperative seizure and functional outcomes.
Statistical analysis including time to seizure recurrence and comparison of surgical techniques.

Keywords:

Rasmussen encephalitis UCLA epilepsy hemispherectomy

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Main Results:

Seizure freedom rates were 68% (1 year), 48% (5 years), and 22% (10 years).
Median time to seizure recurrence was 39 weeks.
Anatomical hemispherectomy was associated with longer seizure recurrence-free time compared to functional hemispherectomy (p=0.03).
Postoperative ambulation (68%) and speech (84%) were maintained regardless of intervention.

Conclusions:

Epilepsy surgery for RE provides palliative seizure control, not a definitive cure.
Anatomical hemispherectomy may offer a longer seizure-free interval.
Long-term seizure relapse is common in RE patients post-surgery.