title: Developmental plasticity after right hemispherectomy in an epileptic adolescent with early brain injury.
abstract: 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.
authors.affiliation: Department of Medical and Surgical Pediatrics and Developmental Neuroscience, Unit of Neuropsichiatria Infantile, Catholic University, Policlinico Gemelli, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Chiricozzi
authors.forename: D
authors.initials: D
authors.lastname: Chieffo
authors.forename: D
authors.initials: D
authors.lastname: Battaglia
authors.forename: L
authors.initials: L
authors.lastname: Iuvone
authors.forename: C
authors.initials: C
authors.lastname: Acquafondata
authors.forename: L
authors.initials: L
authors.lastname: Cesarini
authors.forename: A
authors.initials: A
authors.lastname: Sacco
authors.forename: R
authors.initials: R
authors.lastname: Chiera
authors.forename: C
authors.initials: C
authors.lastname: Di Rocco
authors.forename: F
authors.initials: F
authors.lastname: Guzzetta
mesh_terms: 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
chemical_list: D000927:Anticonvulsants