Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients.
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.
Terra-Bustamante
Vera Cristina
VC
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
Inuzuka
Luciana Midori
LM
Fernandes
Regina Maria França
RM
Escorsi-Rosset
Sara
S
Wichert-Ana
Lauro
L
Alexandre
Veriano
V
Bianchin
Marino M
MM
Araújo
David
D
Santos
Antônio Carlos
AC
Oliveira dos Santos
Ricardo
R
Machado
Helio Rubens
HR
Sakamoto
Américo Ceiki
AC
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