[Lessons learnt from 101 hemispherotomies in children with symptomatic epilepsy. Part I: seizure outcome]
| Autor: | L V Shishkina, M.O. Demin, A G Melikyan, I.A. Nagorskaya, S B Buklina, A B Kozlova, E.I. Shults, P.A. Vlasov, Yu V Strunina |
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| Rok vydání: | 2021 |
| Předmět: |
Pediatrics
medicine.medical_specialty Hemimegalencephaly Hemispherectomy Tuberous sclerosis Epilepsy Seizures Medicine Humans Child Retrospective Studies business.industry Infant Retrospective cohort study Electroencephalography Angiomatosis medicine.disease Hemiparesis Treatment Outcome Child Preschool Cohort Etiology Encephalitis Neurology (clinical) medicine.symptom business |
| Zdroj: | Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko. 85(5) |
| ISSN: | 0042-8817 |
| Popis: | OBJECTIVE To evaluate variables that may predict the outcome after hemispherotomy basing on a retrospective study of a large consecutive pediatric cohort of patients from a single institution. MATERIAL AND METHODS One hundred and one patients with refractory seizures and variable decline in development (n=78) underwent hemispherotomy (med. age - 43 months, med. epilepsy history - 30 months). Developmental pathology was the anatomical substrate of disorder in 42 patients, while the infantile post-stroke scarring and gliosis was its origin in the majority of 43 cases with acquired etiology. The progressive pathology (the Rasmussen encephalitis, Sturge-Weber angiomatosis and tuberous sclerosis) was the etiology in 16 children. Left-sided hemisphere was impaired in 54 cases; some contralateral anatomical and potentially epileptogenic MRI-abnormalities were noted also in «healthy» hemisphere in ¼ of all cases. Eight patients needed second surgery to complete sectioning of undercut commissural fibers. FU is known in 91 patients (med. - 1.5 years) and 73 of them were free of seizures (80.2%), but only 30 of 40 patients with FU > 2 years were still SF (75%). All but one of re-do hemispherotomies were successful. AED-treatment was discontinued in 46 cases and tapered in other 27 patients. Up to 90% of kids demonstrated some improvement in behavior and cognition. RESULTS AND CONCLUSION Developmental pathology, infantile spasms and younger age onset of seizures are negative predictors for achievement of SF-status (p |
| Databáze: | OpenAIRE |
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