title: Etiology-specific differences in motor function after hemispherectomy.
abstract: Prediction of functional motor outcome after hemispherectomy is difficult due to the heterogeneity of motor outcomes observed. We hypothesize that this might be related to differences in plasticity during the onset of the underlying epileptogenic disorder or lesion and try to identify predictors of motor outcome after hemispherectomy. Thirty-five children with different etiologies (developmental, stable acquired or progressive) underwent functional hemispherectomy and motor function assessment before hemispherectomy and 24 months after hemispherectomy. Preoperatively, children with developmental etiologies performed better in terms of distal arm strength and hand function, but not on gross motor function tests. Postoperatively, the three etiology groups performed equally poor in muscle strength and hand function, but gross motor function improved in those with acquired and progressive etiologies. Loss of voluntary hand function and distal arm strength after surgery was associated with etiology, intact insular cortex and intact structural integrity of the ipsilesional corticospinal tract on presurgical MRI scans. In conclusion, postoperative motor function can be predicted more precisely based on etiology and on preoperative MRI. Children with developmental etiology more often lose distal arm strength and hand function and show less improvement in gross motor function, compared to those with acquired pathology.
authors.affiliation: Department of Neurology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands. N.vanderkolk@neuro.umcn.nl
authors.forename: Nicolien M
authors.initials: NM
authors.lastname: van der Kolk
authors.forename: Kim
authors.initials: K
authors.lastname: Boshuisen
authors.forename: Ron
authors.initials: R
authors.lastname: van Empelen
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Koudijs
authors.forename: Martin
authors.initials: M
authors.lastname: Staudt
authors.forename: Peter C
authors.initials: PC
authors.lastname: van Rijen
authors.forename: Onno
authors.initials: O
authors.lastname: van Nieuwenhuizen
authors.forename: Kees P J
authors.initials: KP
authors.lastname: Braun
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020938:Epilepsy, Partial, Motor / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D009048:Motor Skills / Q000502:physiology*; D019957:Motor Skills Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D053580:Muscle Strength / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome