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Updated: Jul 11, 2025
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Determinants of Functional Outcome after Pediatric Hemispherotomy
Georgia Ramantani1, Dorottya Cserpan1, Martin Tisdall2
1Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland.
Insights
Functional outcomes after pediatric hemispherotomy depend on the cause of brain abnormalities and their bilaterality. Older age at evaluation improved walking and speaking abilities, while longer epilepsy duration impacted language.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Hemispherotomy is a surgical procedure for intractable epilepsy, involving disconnection of one cerebral hemisphere.
- Functional outcomes, including motor and speech abilities, are crucial for assessing the success of hemispherotomy in children.
- Identifying determinants of functional outcome is essential for patient selection and post-operative management.
Purpose of the Study:
- To evaluate the determinants of functional outcomes, specifically unaided walking, voluntary grasping, and speaking, after pediatric hemispherotomy.
- To analyze a large, recent multicenter cohort to identify factors influencing functional recovery.
- To utilize advanced statistical modeling for robust identification of outcome predictors.
Main Methods:
- Retrospective analysis of 455 children undergoing hemispherotomy across 5 epilepsy centers (2000-2016).
- Assessment of functional outcomes: unaided walking, voluntary grasping, and speaking.
- Bayesian multivariable regression modeling with missing data imputation to identify determinants.
Main Results:
- High seizure freedom rate (75%) and medication cessation (44%) at a mean follow-up of 5.1 years.
- Seventy-seven percent achieved unaided walking, 8% voluntary grasping, and 68% speech.
- Predictors of poor walking included contralateral MRI abnormalities, recurrent seizures, and lower postsurgical intellectual functioning. Rasmussen encephalitis and Sturge-Weber syndrome were associated with poor grasping. Contralateral MRI abnormalities and longer epilepsy duration predicted impaired speech.
Conclusions:
- Etiology and bilaterality of brain abnormalities are key determinants of functional outcome post-hemispherotomy.
- Longer epilepsy duration negatively impacts language outcomes.
- Older age at outcome evaluation correlates with improved walking and speaking abilities.
Objective:
We aimed to evaluate determinants of functional outcome after pediatric hemispherotomy in a large and recent multicenter cohort.
Methods:
We retrospectively investigated the functional outcomes of 455 children who underwent hemispherotomy at 5 epilepsy centers in 2000-2016. We identified determinants of unaided walking, voluntary grasping with the hemiplegic hand, and speaking through Bayesian multivariable regression modeling using missing data imputation.
Results:
Seventy-five percent of children were seizure-free, and 44% stopped antiseizure medication at a 5.1-year mean follow-up (range = 1-17.1). Seventy-seven percent of children could walk unaided, 8% could grasp voluntarily, and 68% could speak at the last follow-up. Children were unlikely to walk when they had contralateral magnetic resonance imaging (MRI) abnormalities (40/73, p = 0.04), recurrent seizures following hemispherotomy (62/109, p = 0.04), and moderately (50/61, p = 0.03) or severely impaired (127/199, p = 0.001) postsurgical intellectual functioning, but were likely to walk when they were older at outcome determination (p = 0.01). Children were unlikely to grasp voluntarily with the hand contralateral to surgery when they had Rasmussen encephalitis (0/61, p = 0.001) or Sturge-Weber syndrome (0/32, p = 0.007). Children were unlikely to speak when they had contralateral MRI abnormalities (30/69, p = 0.002) and longer epilepsy duration (p = 0.01), but likely to speak when they had Sturge-Weber syndrome (29/35, p = 0.01), were older at surgery (p = 0.04), and were older at outcome determination (p < 0.001).
Interpretation:
Etiology and bilaterality of structural brain abnormalities were key determinants of functional outcome after hemispherotomy. Longer epilepsy duration affected language outcomes. Not surprisingly, walking and talking ability increased with older age at outcome evaluation. ANN NEUROL 2024;95:377-387.
