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Language after childhood hemispherectomy: A systematic review
Andrea S Nahum1, Frédérique J Liégeois2
1From the Cognitive Neuroscience and Neuropsychiatry Section (A.S.N., F.J.L.), UCL Great Ormond Street Institute of Child Health; and UCL Medical School (A.S.N.), University College London, London, United Kingdom.
Neurology
|October 22, 2020
Summary
Language outcomes after hemispherectomy (surgical removal of a cerebral hemisphere) are generally poor, especially in children with cortical dysplasia. Etiology significantly impacts postsurgical language recovery, necessitating early specialist evaluation.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Psychology
Background:
- Hemispherectomy is a radical surgical procedure for intractable epilepsy.
- Understanding long-term language outcomes is crucial for patient management and rehabilitation.
Purpose of the Study:
- To systematically review language outcomes following left and right hemispherectomy in children.
- To identify factors influencing language recovery after hemispherectomy.
Main Methods:
- Systematic review of observational studies (1988-2019) on hemispherectomy in individuals under 18.
- Inclusion of studies with standardized language assessments (vocabulary, comprehension, production).
- Calculation of mean z-scores for language skills post-surgery.
Main Results:
- 17 studies with 205 participants (62% left hemispherectomy) were included.
- Left hemispherectomy led to impaired language skills (z < -1.5), except sentence comprehension.
- Right hemispherectomy resulted in borderline language performance (z ~ -1.5).
- Cortical dysplasia showed the worst outcomes (z < -2.5); vascular etiology and Rasmussen syndrome had better outcomes.
Conclusions:
- High risk of language impairment after hemispherectomy, with etiology being a key factor in plasticity.
- Specialist language evaluation post-surgery is recommended for targeted interventions.
- Further large-scale studies on consecutive cases are needed.
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