Developmental plasticity after right hemispherectomy in an epileptic adolescent with early brain injury.
OBJECTIVE
The authors present the case of an adolescent affected with refractory epilepsy due to a neonatal ischemic infarction of the right medial cerebral artery. Hemiplegic since the first months of life, she began presenting motor partial seizures associated with drop attacks at 4.5 years; these were initially well controlled by antiepileptic drugs, but at 10 years seizures appeared again and became refractory. Thus, at 14 years and 10 months, she was submitted to a right hemispherectomy that made her rapidly seizure free. In the post-surgical follow-up lasting 5 years, neuropsychological serial assessments showed an impressive progressive improvement of cognitive skills, namely, visuospatial abilities. This case seems to challenge the widely spread feeling that functional catch-up in brain-injured children could only occur early in life. In effect, the astonishing recovery especially of visuospatial skills in our case occurred in adolescence after a late surgical intervention of right hemispherectomy.


METHODS
Different neuropsychological aspects are discussed. The reorganisation process recovered the spatial and linguistic abilities as well as the verbal and visuospatial memory; however, there was a persistent impairment of complex spatial and perceptual skills as well as recall abilities. Despite the deficit of complex visual stimuli processing, the patient showed a good performance in the recognition of unknown faces.


CONCLUSIONS
Probably, the absence of seizures in the first 4 years of life could have allowed a generally adequate compensatory reorganisation, successively masked by the persistent and diffuse epileptic disorder. The seizure control produced by surgery eventually made evident the effectiveness of the brain reorganisation.
Chiricozzi
F
F
Department of Medical and Surgical Pediatrics and Developmental Neuroscience, Unit of Neuropsichiatria Infantile, Catholic University, Policlinico Gemelli, Rome, Italy.
Chieffo
D
D
Battaglia
D
D
Iuvone
L
L
Acquafondata
C
C
Cesarini
L
L
Sacco
A
A
Chiera
R
R
Di Rocco
C
C
Guzzetta
F
F
D000293:Adolescent; D000328:Adult; D000513:Alpha Rhythm; D000927:Anticonvulsants / Q000008:administration & dosage; D001925:Brain Damage, Chronic / Q000209:etiology / Q000601:surgery*; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004292:Dominance, Cerebral / Q000502:physiology; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D017029:Epilepsy, Complex Partial / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D038421:Hemispherectomy; D006801:Humans; D007223:Infant; D020244:Infarction, Middle Cerebral Artery / Q000150:complications*; D007807:Language Tests; D009473:Neuronal Plasticity / Q000502:physiology*; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000503:physiopathology*; D020127:Recovery of Function; D012640:Seizures / Q000503:physiopathology; D013826:Theta Rhythm
D000927:Anticonvulsants