Long-term musculoskeletal outcomes in pediatric hemispherotomy

The purpose of this study is to describe long-term functional mobility and musculoskeletal interventions in a group of pediatric patients who underwent hemispherotomy and hemispherectomy (HS) for drug-resistant epilepsy.

We conducted a retrospective review of patients who underwent HS at UPMC Children's Hospital of Pittsburgh from 1997 to 2023 with at least 1 year of follow-up. Gross Motor Function Classification System (GMFCS) levels and data on upper extremity function were collected pre-operatively and at 1-, 2-, 5-, 10-, and 15-years post-HS for each patient. Musculoskeletal interventions including use of orthotic devices, chemodenervation, and orthopedic surgery were also documented for each patient at follow-up timepoints.

A total of 35 patients (51.4 % female) underwent HS at 4.26 ± 4.26 years old for drug-resistant epilepsy and presented for follow-up at 1 (n = 35), 2 (n = 29), 5 (n = 19), 10 (n = 15), and 15 (n = 13) years post-HS. All patients had post-operative hemiparesis with upper extremity functioning exhibiting the expected proximal-to-distal gradient in impairment. 20 patients (57 %) experienced no change in GMFCS levels throughout follow-up while 14 (40 %) showed improvement in GMFCS level. Use of orthotics at each timepoint ranged from 78 % to 100 % of the cohort. In total, 11 (34 %) patients underwent at least one round of chemodenervation and 11 (34 %) underwent at least one orthopedic surgical procedure.

Our study demonstrates that children who undergo HS experience minimal long-term impact on broad measures of functional mobility but may still require intervention for management of spasticity, muscle contractures, and bony deformities.