title: Hemispherectomy in pediatric patients with epilepsy: a study of 45 cases with special emphasis on epileptic syndromes.
abstract: OBJECTIVE
  In this study we report the clinical outcomes of hemispherectomy for epilepsy in pediatric patients with special emphasis on the epileptic syndromes and their etiologies.
  
  
  METHODS
  We retrospectively studied 45 patients with medically refractory epilepsy with hemispheric lesions who underwent hemispherectomy at the "Hospital de Pediatría Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina between February 1990 and February 2010. Patients had been assessed using a standard protocol involving clinical, neuroradiological, neurophysiological, and neuropsychological teams.
  
  
  RESULTS
  Twenty-seven males and 18 females with a mean age of 8.5 years (range, 2 months to 18 years) who underwent epilepsy surgery for refractory epilepsy were assessed. The mean time of follow-up was 9.5 years (range, 1 to 16 years). The following epileptic syndromes were recognized: West syndrome in 15 patients (33.5%), Rasmussen syndrome in 13 (29%), focal symptomatic epilepsy in 8 (17.5%), startle epilepsy in 6 (13.5%), Lennox-Gastaut syndrome in 2 (5%), and continuous spikes and waves during slow sleep in 1 (2%). The surgical specimens revealed malformations of cortical development in 18 patients (40%), Rasmussen encephalitis in 13 (29%), porencephalic lesions in 10 (22%), gliosis in 2 (4.4%), tumor in 1 (2.2%), and Sturge-Weber syndrome in 1 (2.2%).
  
  
  CONCLUSIONS
  The outcome of hemispherectomy in pediatric patients is good for those with refractory epilepsies, such as West syndrome, Lennox-Gastaut syndrome, epileptic encephalopathy with continuous spikes and waves during slow sleep, and startle epilepsy arising from a hemispheric lesion associated with hemiplegia.
authors.affiliation: Neurology Department, Hospital Nacional de Pediatría Prof Dr Juan P Garrahan, Combate de los Pozos 1881, CP 1245 Buenos Aires, Argentina. rhcaraballo@arnet.com.ar
authors.forename: Roberto
authors.initials: R
authors.lastname: Caraballo
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bartuluchi
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cersósimo
authors.forename: Alejandra
authors.initials: A
authors.lastname: Soraru
authors.forename: Hugo
authors.initials: H
authors.lastname: Pomata
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D010372:Pediatrics; D012189:Retrospective Studies; D016896:Treatment Outcome