Seizure and developmental outcomes after hemispherectomy in children and adolescents with intractable epilepsy
| Autor: | María-Ángeles Pérez-Jiménez, Marcelo Budke, María-Luz Ruiz-Falcó, Martín Fabregate-Fuente, Concepción Fournier-Del Castillo, Marta García-Fernández, Inmaculada De Prada-Vicente, Francisco Villarejo-Ortega, Juan Álvarez-Linera |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Adolescent Hemispherectomy medicine.medical_treatment Neuropsychological Tests Electroencephalography Epilepsy Child Development Seizures medicine Humans Epilepsy surgery Global developmental delay Child Cerebrum Neuronal Plasticity medicine.diagnostic_test business.industry Age Factors Infant Newborn Neuropsychology Infant Spike-and-wave Recovery of Function General Medicine medicine.disease Adaptation Physiological Treatment Outcome Child Preschool Anesthesia Pediatrics Perinatology and Child Health Female Neurology (clinical) Neurosurgery business Follow-Up Studies |
| Zdroj: | Child's Nervous System. 29:475-488 |
| ISSN: | 1433-0350 0256-7040 |
| DOI: | 10.1007/s00381-012-1949-8 |
| Popis: | The aim of this study is to describe a series of pediatric hemispherectomies, reviewing pathologic substrate, epilepsy characteristics and seizure outcome as well as developmental profiles, before and after surgery, in different domains. Seventeen patients with full pre-surgical work-up, minimum follow-up of 12 months, and at least one post-surgical neuropsychological evaluation were selected. Three had Rasmussen encephalitis (RE), five hemispheric malformations of cortical development (MCD), and nine hemispheric vascular lesions. At latest follow-up, all patients with RE and 66.7 % of those with vascular lesions are in Engel’s class I; in the latter group, pre-surgical independent contralateral EEG discharges statistically correlated with a worse seizure outcome. Patients with MCD showed the worst seizure outcome. Pre-surgical language transfer to the right hemisphere was confirmed in a boy with left RE, operated on at 6 years of age. Patients with MCD and vascular lesions already showed severe global developmental delay before surgery, which persists afterwards. A linear correlation was found between earlier age at surgery and better outcome in personal–social, gross motor, and adaptive domains, in the vascular lesions group. The case with highest cognitive improvement had continuous spike and wave during sleep on pre-surgical EEG. Pathologic substrate was the main factor related with seizure outcome. In children with MCD and vascular lesions, although developmental progression is apparent, significant post-surgical improvements are restricted by the severity of pre-surgical neuropsychological disturbances and a slow maturation. Early surgery assessment is recommended to enhance the possibilities for a better quality of life in terms of seizure control, as well as better autonomy and socialization. |
| Databáze: | OpenAIRE |
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