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Impact of Etiology on Seizure and Quantitative Functional Outcomes in Children with Cerebral Palsy and Medically
Mark A Damante1, Nathan Rosenberg2, Ammar Shaikhouni3
1The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA.
Insights
Hemispherectomy surgery for children with cerebral palsy and intractable epilepsy showed similar seizure control and functional outcomes regardless of whether the cause was vascular or dysplastic. Comprehensive therapy led to minor functional declines post-surgery.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epilepsy Research
Background:
- Medically intractable epilepsy in children with cerebral palsy (CP) often necessitates surgical intervention.
- Vascular and dysplastic etiologies represent distinct pathological origins for CP and associated epilepsy.
Purpose of the Study:
- To compare seizure control and functional outcomes in pediatric patients with CP and intractable epilepsy undergoing hemispherectomy.
- To evaluate differences in outcomes based on whether the underlying etiology was vascular or dysplastic.
Main Methods:
- A review of consecutive pediatric patients undergoing functional or anatomic hemispherectomy between 07/01/2015 and 12/01/2019.
- Assessment of seizure outcomes using the Engel classification and functional outcomes via the Functional Independence Measure for Children ( fungsi ).
Main Results:
- Seizure freedom was achieved in 11 of 18 patients (mean follow-up 2 years 8 months), with no significant difference between vascular (5/7) and dysplastic (6/11) etiologies (P=0.64).
- Functional Independence Measure for Children ( fungsi ) scores showed no significant differences in changes between groups across various time points (pre-operative to inpatient, inpatient to discharge, pre-operative to follow-up).
Conclusions:
- Functional and seizure outcomes after hemispherectomy for pediatric cerebral palsy with intractable epilepsy do not significantly differ between vascular and dysplastic etiologies.
- Hemispheric surgery, followed by multidisciplinary therapy, resulted in minimal functional declines from baseline.
Objective:
To compare functional and seizure outcomes in children with vascular and dysplastic etiologies of cerebral palsy and medically intractable epilepsy following functional hemispherotomy or anatomic hemispherectomy.
Methods:
Consecutive patients satisfying inclusion criteria from 07/01/2015 to 12/01/2019 were reviewed for demographic data and seizure (Engel classification) and functional (Functional Independence Measure for Children) outcomes.
Results:
After a mean follow-up of 2 years 8 months (1 year 2 months), 11 of 18 patients achieved post-operative seizure freedom without significant difference between vascular (5/7) and dysplastic (6/11) etiologies (P = 0.64). Functional assessments were completed for 15 of 18 of subjects, split comparably between groups. Mean change in the Functional Independence Measure for Children from pre-operative baseline to inpatient rehabilitation admission (vascular, -35.3 [13.2]; malformation of cortical development{MCD}, -34.5 [25.0]; P = 0.69), inpatient rehabilitation admission to discharge (vascular, 18.7 [9.0]; MCD, 20.8 [11.4]; P = 0.60), and pre-operative evaluation to clinic follow-up (vascular, -7.6 [9.7]; MCD, -3.6 [19.3]; P = 0.61) did not differ between groups.
Conclusion:
Quantitative functional and seizure outcomes following functional hemispherotomy or anatomic hemispherectomy did not differ significantly between vascular and dysplastic etiologies of cerebral palsy and medically intractable epilepsy in this study. Hemispheric surgery resulted in minor functional declines from baseline following comprehensive multidisciplinary therapy.
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