Functional hemispherectomy in children with epilepsy and CSWS due to unilateral early brain injury including thalamus: sudden recovery of CSWS.
OBJECTIVE
To try to prove in patients with refractory symptomatic epilepsy due to early brain injury involving thalamus and complicated by CSWS the effects of the isolation of the injured hemisphere, performed with functional hemisperectomy, on epilepsy, namely on CSWS.


METHODS
Full clinical follow-up before and after surgery of two cases with CSWS onset at four years in whom functional hemispherecomy was performed with resection of inter-hemispheric connections.


RESULTS
An immediate effectiveness of the surgical treatment was observed on both epileptic evolution (no more seizures) and EEG abnormalities. In particular, CSWS completely disappeared, together with a concurrent progressive improving of the cognitive and behavioural disorders.


CONCLUSIONS
The isolation of the injured hemisphere through the section of inter-hemispheric cortico-cortical connections could prevent the contralateral diffusion of discharges coming from the injured cortex and cortico-thalamic network, favouring a normal function of thalamo-cortico-thalamic circuitries in the healthy hemisphere. That could explain the disappearance of CSWS after surgery in our patients and the consequent improvement of cognitive abilities and behaviour.
Battaglia
D
D
Child Neurology, Catholic University of the Sacred Heart, Rome, Italy.
Veggiotti
P
P
Lettori
D
D
Tamburrini
G
G
Tartaglione
T
T
Graziano
A
A
Veredice
C
C
Sacco
A
A
Chieffo
D
D
Pecoraro
A
A
Colosimo
C
C
Di Rocco
C
C
Dravet
Ch
Ch
Guzzetta
F
F
D017668:Age of Onset; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D002540:Cerebral Cortex / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy; D006801:Humans; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013788:Thalamus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome