Discordant electroencephalogram epileptiform activity and hemispherectomy in children with refractory epilepsy and...

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Epileptology

Background:

• Unilateral cerebral palsy and hemispheric lesions can present complex epilepsy profiles.
• Electroencephalogram (EEG) findings in these cases may show paradoxical or bilateral abnormalities, complicating surgical candidacy assessment.

Purpose of the Study:

• To evaluate the surgical candidacy and outcomes of functional hemispherectomy in children with unilateral cerebral palsy and hemispheric encephaloclastic lesions.
• To determine if discordant electroclinical data should preclude hemispherectomy in refractory epilepsy.

Main Methods:

• Case series of six children with unilateral cerebral palsy and hemispheric lesions undergoing epilepsy surgery.
• Detailed reporting of clinical data, EEG, electrocorticography, neuroimaging, and histology.
• Functional hemispherectomy performed in children aged 4-11 years with 1-10 year follow-up.

Main Results:

• All six children proceeded to functional hemispherectomy despite discordant EEG findings.
• Good clinical outcomes were observed in the follow-up period (1-10 years).
• Contralateral or bilateral EEG abnormalities did not negatively impact surgical outcomes.

Conclusions:

• Early surgical evaluation for refractory epilepsy is recommended in children with complex profiles and discordant investigations.
• Functional hemispherectomy can be a successful treatment option for selected children with unilateral cerebral palsy, hemiparesis, and uniclastic lesions, irrespective of EEG lateralization.
• Discordant EEG findings should not deter consideration of hemispherectomy in appropriate pediatric epilepsy cases.