Case Report: Behavioral Disorder Following Hemispherotomy: A Valproate Effect?

Area of Science:

• Neurology
• Neurosurgery
• Pediatric Epilepsy

Background:

• Hemispherotomy is a surgical procedure for intractable epilepsy caused by unilateral brain lesions.
• This surgery involves disconnecting one cerebral hemisphere, leading to significant brain reorganization.
• Understanding post-surgical neurological and behavioral changes is crucial for patient management.

Observation:

• A 9-year-old boy with drug-resistant epilepsy underwent hemispherotomy.
• Post-surgery, his existing behavioral problems significantly worsened, with new aggressive symptoms emerging.
• The patient was on long-term treatment with valproic acid and lamotrigine.

Findings:

• A potential link was observed between valproic acid (VPA) and the acute behavioral deterioration post-hemispherotomy.
• Tapering and discontinuing VPA led to a marked decrease and eventual resolution of behavioral problems.
• This suggests VPA may interact with brain network reorganization following hemispherotomy.

Implications:

• This case highlights the potential for altered anticonvulsant effects, specifically valproic acid, during post-hemispherotomy brain plasticity.
• Clinicians should consider medication adjustments, particularly VPA, when significant behavioral changes occur after hemispherotomy.
• Further research is needed to elucidate the mechanisms underlying VPA's interaction with neuroreorganization in epilepsy surgery patients.