title: Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients.
abstract: BACKGROUND
  Hemispheric brain lesions are commonly associated with early onset of catastrophic epilepsies and multiple seizure types. Hemispheric surgery is indicated for patients with unilateral intractable epilepsy. Although described more than 50 years ago, several new techniques for hemispherectomy have only recently been proposed aiming to reduce operatory risks and morbidity.
  
  
  METHODS
  We present the clinical characteristics, presurgical workup, and postoperative outcome of a series of pediatric patients who underwent hemispherectomy for medically intractable epileptic seizures. Thirty-nine patients with medically intractable epilepsy underwent surgery from 1996 to 2005.
  
  
  CONCLUSIONS
  We analyzed demographic data, interictal and ictal EEG findings, age at surgery, surgical technique and complications, and postsurgical seizure outcome. There were 74.4% males. Tonic and focal motor seizures occurred in 30.8 and 20.5% of the patients. Most frequent etiologies were Rasmussen encephalitis (30.8%) and malformation of cortical development (23.1%). Postsurgical outcomes were Engel classes I and II for 61.5% of the patients. In general, 89.5% of the patients exhibited at least a 90% reduction in seizure frequency. All patients had acute worsening of hemiparesis after surgery. Basically, two surgical techniques have been employed, both with similar results, although a trend has been noted toward one of the procedures which produced consistently complete disconnection. Patients with hemispheric brain lesions usually have abnormal neurological development and intractable epilepsy. When video-EEG monitoring and magnetic resonance imaging show unilateral disease, the patient may evolve with a good surgical outcome. We showed that a marked reduction in seizure frequency may be achieved, with acceptable neurological impairments.
authors.affiliation: Department of Neurology, Psychiatry and Psychology, Ribeirão Preto School of Medicine, University of São Paulo, CEP 14048-900 Ribeirão Preto, São Paulo, Brazil. vctbusta@mp.fmrp.usp.br
authors.forename: Vera Cristina
authors.initials: VC
authors.lastname: Terra-Bustamante
authors.forename: Luciana Midori
authors.initials: LM
authors.lastname: Inuzuka
authors.forename: Regina Maria França
authors.initials: RM
authors.lastname: Fernandes
authors.forename: Sara
authors.initials: S
authors.lastname: Escorsi-Rosset
authors.forename: Lauro
authors.initials: L
authors.lastname: Wichert-Ana
authors.forename: Veriano
authors.initials: V
authors.lastname: Alexandre
authors.forename: Marino M
authors.initials: MM
authors.lastname: Bianchin
authors.forename: David
authors.initials: D
authors.lastname: Araújo
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Santos
authors.forename: Ricardo
authors.initials: R
authors.lastname: Oliveira dos Santos
authors.forename: Helio Rubens
authors.initials: HR
authors.lastname: Machado
authors.forename: Américo Ceiki
authors.initials: AC
authors.lastname: Sakamoto
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D011788:Quality of Life; D018709:Statistics, Nonparametric; D016896:Treatment Outcome