Long term outcome of functional hemispherectomy for refractory epilepsy: Experience from a single center
Autor: | Alfredo Calheiros, João Chaves, Rui Rangel, Teresa Temudo, João Ramalheira, Sérgio Tavares de Sousa, António Martins da Silva, Vasco Sá Pinto, José Lopes Lima, João Peças Lopes |
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Rok vydání: | 2022 |
Předmět: |
Adult
Drug Resistant Epilepsy Pediatrics medicine.medical_specialty Hemispherectomy medicine.medical_treatment Single Center 03 medical and health sciences Epilepsy 0302 clinical medicine medicine Humans In patient Child business.industry Electroencephalography medicine.disease Engel classification Treatment Outcome Functional hemispherectomy Child Preschool Refractory epilepsy Surgery Neurology (clinical) Epilepsy unit business 030217 neurology & neurosurgery Follow-Up Studies |
Zdroj: | Neurocirugía. 33:82-89 |
ISSN: | 1130-1473 |
Popis: | Background Hemispherectomy has an established role as a treatment of last resort in patients with unilateral hemispheric lesions suffering from refractory epilepsy. Methods Seven patients were evaluated at our Epilepsy Unit. We compared the seizure outcome at 6 months, 1, 2, 5 years post-surgery, as well as at end follow-up (mean 7.1 years) using Engel classification. Reduction of antiepileptic drugs (AEDs) was also assessed utilizing equal time frames. Results The mean age of seizure onset was 5.4 years. Engel I was achieved in 5 patients at 6 months (71.4%). Engel at 1 year was predicted by the Engel at 6 months (p = 0.013) with a similar number of patients being classified as Engel I outcome. Engel at 2 years was also predicted by Engel at 6 months and at 1 year (p = 0.030). At end follow-up only 3 patients (42.9%) remained categorized as Engel I outcome. There was a trend toward a stability in Engel classification. All patients with developmental causes for their epilepsy experienced some deterioration of the surgical outcomes. Conversely, all patients with acquired causes were stable throughout follow-up. Seizure outcome at 6 months was worse in the patients who had post-op complications (p = 0.044). Adult and pediatric populations did not differ significantly in any tested variable. Conclusions Hemispherectomy is a valuable resource for seizure control in properly selected patients. Engel patient's evolution could be predicted at 6 months interval. Hemispherectomy could be considered a useful attitude in difficult cases. |
Databáze: | OpenAIRE |
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