Hemispheric surgery in children with refractory epilepsy: seizure outcome, complications, and adaptive function.
OBJECTIVE
To describe seizure control, complications, adaptive function and language skills following hemispheric surgery for epilepsy.


METHODS
Retrospective chart review of patients who underwent hemispheric surgery from July 1993 to June 2004 with a minimum follow-up of 12 months.


RESULTS
The study population comprised 24 children, median age at seizure onset six months and median age at surgery 41 months. Etiology included malformations of cortical development (7), infarction (7), Sturge-Weber Syndrome (6), and Rasmussen's encephalitis (4). The most frequent complication was intraoperative bleeding (17 transfused). Age <2 yr, weight <11 kg, and hemidecortication were risk factors for transfusion. Postoperative complications included aseptic meningitis (6), and hydrocephalus (3). At median follow-up of 7 yr, 79% of patients are seizure free. Children with malformations of cortical development and Rasmussen's encephalitis were more likely to have ongoing seizures. Overall adaptive function scores were low, but relative strengths in verbal abilities were observed. Shorter duration of epilepsy prior to surgery was related significantly to better adaptive functioning.


CONCLUSIONS
Hemispheric surgery is an effective therapy for refractory epilepsy in children. The most common complication was bleeding. Duration of epilepsy prior to surgery is an important factor in determining adaptive outcome.
Basheer
Sheikh Nigel
SN
Division of Neurology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Connolly
Mary B
MB
Lautzenhiser
Aaron
A
Sherman
Elisabeth M S
EM
Hendson
Glenda
G
Steinbok
Paul
P
D000293:Adolescent; D002540:Cerebral Cortex / Q000002:abnormalities; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000523:psychology / Q000601:surgery; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D038421:Hemispherectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008582:Meningitis, Aseptic; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome