[Case of severe epilepsy treated by 2-stage hemispherectomy]

The authors describe a 7-year-old boy with severe epilepsy cured by means of two-stage hemispherectomy. Epileptic seizures occurred in the left extremities and recurred several tens of times daily despite intensive pharmacological treatment. EEG investigations demonstrated seizure activity in the right motor-parietal-temporal area. Stereotaxic destruction of Forel's field and thalamus on the right side gave only brief improvement lasting several days. In view of this the frontal, temporal and a part of the parietal lobe were removed according to electrocorticographic investigations. During 6 months after the operation epileptic attacks were absent, than they recurred with increasing frequency. After 10 months full hemispherectomy was done. The child tolerated the operation very well, and control examination after 2 years showed disappearance of epileptic attacks and considerable compensation of motor power loss and sensory disturbances in the left extremities. The authors believe that hemispherectomy carried out in two stages at an interval of several months is better tolerated by the patients and makes possible better compensation of functional disturbances than classic hemispherectomy. In the discussion the authors stress the importance of extrapyramidal pathways for compensation of motor disturbances.