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Published on: September 7, 2022
Long-term musculoskeletal outcomes in pediatric hemispherotomy
Emily E Harford1, Anisha Mandava1, Ozgur Dede2
1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Insights
Pediatric patients undergoing hemispherotomy (HS) for epilepsy showed minimal long-term functional mobility loss. However, many required interventions for spasticity and related musculoskeletal issues.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Drug-resistant epilepsy in children often necessitates hemispherectomy (HS) or hemispherotomy (HS).
- Long-term outcomes regarding functional mobility and musculoskeletal health post-HS are crucial for patient management.
- Understanding these outcomes informs rehabilitation strategies and interventions.
Purpose of the Study:
- To describe long-term functional mobility in pediatric patients after hemispherotomy (HS) or hemispherectomy (HS).
- To document musculoskeletal interventions required by these patients over time.
- To assess the impact of HS on Gross Motor Function Classification System (GMFCS) levels and upper extremity function.
Main Methods:
- Retrospective review of pediatric patients who underwent HS from 1997-2023 with at least 1-year follow-up.
- Collected pre-operative and post-operative data on GMFCS levels and upper extremity function at multiple timepoints (1, 2, 5, 10, 15 years).
- Documented musculoskeletal interventions including orthotics, chemodenervation, and orthopedic surgery.
Main Results:
- 35 pediatric patients underwent HS, with follow-up data available for varying durations.
- All patients exhibited post-operative hemiparesis; upper extremity impairment followed a proximal-to-distal gradient.
- While 57% had no change in GMFCS levels, 40% improved; orthotic use was high (78-100%), with 34% receiving chemodenervation and 34% undergoing orthopedic surgery.
Conclusions:
- Hemispherotomy (HS) has minimal long-term impact on overall functional mobility in pediatric patients.
- Interventions for spasticity, contractures, and bony deformities remain necessary for managing musculoskeletal complications.
- This highlights the need for ongoing, specialized rehabilitation and orthopedic care post-HS.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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