Contralateral MRI abnormalities affect seizure and cognitive outcome after hemispherectomy.
OBJECTIVE
To explore whether EEG and MRI abnormalities in the "healthy" hemisphere influence seizure and cognitive outcome after functional hemispherectomy.


METHODS
This is a retrospective consecutive cohort study of 43 children who underwent functional hemispherectomy between 1994 and 2008. Results of preoperative EEG recordings were reviewed for the existence of (inter)ictal epileptic or background abnormalities in the contralateral hemisphere. Preoperative MRIs were reexamined for the existence of unequivocal contralateral abnormalities. Postoperative seizure status was assessed, and of 34 children, IQ or mental developmental index (MDI) scores were obtained preoperatively and postoperatively. Seizure freedom was defined as Engel 1A. Contralateral EEG and MRI abnormalities were studied in relation to seizure and cognitive outcome.


RESULTS
Thirty-three children achieved seizure freedom (77%). Of the 11 patients with contralateral MRI abnormalities, only 45% were seizure free, compared with 88% of the 32 patients without contralateral MRI lesions (p = 0.030). Children with contralateral MRI abnormalities more often were severely retarded after surgery (MDI/IQ <55; 90% vs 42%, p = 0.030). Postoperative MDI/IQ scores improved in none of the children with, but in 38% of those without contralateral MRI abnormalities (p = 0.034). Contralateral epileptic or background EEG abnormalities did not affect seizure outcome or postoperative cognitive performance. Four of 6 children with bilateral epileptic encephalopathy reached seizure freedom.


CONCLUSIONS
Unambiguous contralateral MRI abnormalities are significantly associated with seizure recurrence, severe mental delay, and lack of cognitive improvement and may be considered a relative contraindication for hemispherectomy. Contralateral EEG abnormalities do not negatively influence postsurgical outcome.
Rudolf Magnus Institute of Neuroscience, Department of Child Neurology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
K
K
Boshuisen
M M J
MM
van Schooneveld
F S S
FS
Leijten
G A P
GA
de Kort
P C
PC
van Rijen
P H
PH
Gosselaar
O
O
van Nieuwenhuizen
K P J
KP
Braun
D003072:Cognition Disorders / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000150:complications / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome