Pediatric hemispherectomy outcome: Adaptive functioning, intelligence, and memory.

Autor: Shurtleff HA; Neurosciences, Seattle Children's Hospital, United States; Center for Integrated Brain Research, Seattle Children's Hospital, United States. Electronic address: hillary.shurtleff@seattlechildrens.org., Roberts EA; University of Washington School of Medicine, United States., Young CC; Department of Neurological Surgery, University of Washington School of Medicine, United States., Barry D; Clinical Analytics, Seattle Children's Hospital, United States., Warner MH; Neurosciences, Seattle Children's Hospital, United States; Center for Integrated Brain Research, Seattle Children's Hospital, United States., Saneto RP; Neurosciences, Seattle Children's Hospital, United States; Center for Integrated Brain Research, Seattle Children's Hospital, United States; Department of Neurology, University of Washington School of Medicine, United States; Division of Pediatric Neurology, Seattle Children's Hospital, United States., Buckley R; Department of Neurological Surgery, University of Washington School of Medicine, United States., Firman T; Department of Medicine, University of Chicago, United States., Poliakov AV; Radiology, Seattle Children's Hospital, United States., Ellenbogen RG; Neurosciences, Seattle Children's Hospital, United States; Center for Integrated Brain Research, Seattle Children's Hospital, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States., Hauptman JS; Neurosciences, Seattle Children's Hospital, United States; Center for Integrated Brain Research, Seattle Children's Hospital, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States., Ojemann JG; Neurosciences, Seattle Children's Hospital, United States; Center for Integrated Brain Research, Seattle Children's Hospital, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States., Marashly A; Neurosciences, Seattle Children's Hospital, United States; Center for Integrated Brain Research, Seattle Children's Hospital, United States; Department of Neurology, University of Washington School of Medicine, United States; Division of Pediatric Neurology, Seattle Children's Hospital, United States.
Jazyk: angličtina
Zdroj: Epilepsy & behavior : E&B [Epilepsy Behav] 2021 Sep 16; Vol. 124, pp. 108298. Date of Electronic Publication: 2021 Sep 16.
DOI: 10.1016/j.yebeh.2021.108298
Abstrakt: Objective: Our purpose was to characterize neuropsychological evaluation (NP) outcome following functional hemispherectomy in a large, representative cohort of pediatric patients.
Methods: We evaluated seizure and NP outcomes and medical variables for all post-hemispherectomy patients from Seattle Children's Hospital epilepsy surgery program between 1996 and 2020. Neuropsychological evaluation outcome tests used were not available on all patients due to the diversity of patient ages and competency that is typical of a representative pediatric cohort; all patients had at least an adaptive functioning or intelligence measure, and a subgroup had memory testing.
Results: A total of 71 hemispherectomy patients (37 right; 34 females) yielded 66 with both preoperative (PREOP) plus postoperative (POSTOP) NPs and 5 with POSTOP only. Median surgery age was 5.7 (IQR 2-9.9) years. Engel classification indicated excellent seizure outcomes: 59 (84%) Class I, 6 (8%) Class II, 5 (7%) Class III, and 1 (1%) Class IV. Medical variables - including seizure etiology, surgery age, side, presurgical seizure duration, unilateral or bilateral structural abnormalities, secondarily generalized motor seizures - were not associated with either Engel class or POSTOP NP scores, though considerable heterogeneity was evident. Median PREOP and POSTOP adaptive functioning (PREOP n = 45, POSTOP n = 48) and intelligence (PREOP n = 29, POSTOP n = 36) summary scores were exceptionally low and did not reveal group decline from PREOP to POSTOP. Fifty-five of 66 (85%) cases showed stability or improvement. Specifically, 5 (8%) improved; 50 (76%) showed stability; and 11 (16%) declined. Improve and decline groups showed clinically interesting, but not statistical, differences in seizure control and age. Median memory summary scores were low and also showed considerable heterogeneity. Overall median PREOP to POSTOP memory scores (PREOP n = 16, POSTOP n = 24) did not reveal declines, and verbal memory scores improved. Twenty six percent of intelligence and 33% of memory tests had verbal versus visual-spatial discrepancies; all but one favored verbal, regardless of hemispherectomy side.
Significance: This large, single institution study revealed excellent seizure outcome in 91% of all 71 patients plus stability and/or improvement of intelligence and adaptive functioning in 85% of 66 patients who had PREOP plus POSTOP NPs. Memory was similarly stable overall, and verbal memory improved. Medical variables did not predict group NP outcomes though heterogeneity argues for further research. This study is unique for cohort size, intelligence plus memory testing, and evidence of primacy of verbal over visual-spatial development, despite hemispherectomy side. This study reinforces the role of hemispherectomy in achieving good seizure outcome while preserving functioning.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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