title: Seizure and developmental outcomes after hemispherectomy in children and adolescents with intractable epilepsy.
abstract: OBJECTIVE
  The aim of this study is to describe a series of pediatric hemispherectomies, reviewing pathologic substrate, epilepsy characteristics and seizure outcome as well as developmental profiles, before and after surgery, in different domains.
  
  
  METHODS
  Seventeen patients with full pre-surgical work-up, minimum follow-up of 12 months, and at least one post-surgical neuropsychological evaluation were selected. Three had Rasmussen encephalitis (RE), five hemispheric malformations of cortical development (MCD), and nine hemispheric vascular lesions.
  
  
  RESULTS
  At latest follow-up, all patients with RE and 66.7 % of those with vascular lesions are in Engel's class I; in the latter group, pre-surgical independent contralateral EEG discharges statistically correlated with a worse seizure outcome. Patients with MCD showed the worst seizure outcome. Pre-surgical language transfer to the right hemisphere was confirmed in a boy with left RE, operated on at 6 years of age. Patients with MCD and vascular lesions already showed severe global developmental delay before surgery, which persists afterwards. A linear correlation was found between earlier age at surgery and better outcome in personal-social, gross motor, and adaptive domains, in the vascular lesions group. The case with highest cognitive improvement had continuous spike and wave during sleep on pre-surgical EEG.
  
  
  CONCLUSIONS
  Pathologic substrate was the main factor related with seizure outcome. In children with MCD and vascular lesions, although developmental progression is apparent, significant post-surgical improvements are restricted by the severity of pre-surgical neuropsychological disturbances and a slow maturation. Early surgery assessment is recommended to enhance the possibilities for a better quality of life in terms of seizure control, as well as better autonomy and socialization.
authors.affiliation: Neurosurgery Service, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Villarejo-Ortega
authors.forename: Marta
authors.initials: M
authors.lastname: García-Fernández
authors.forename: Concepción
authors.initials: C
authors.lastname: Fournier-Del Castillo
authors.forename: Martín
authors.initials: M
authors.lastname: Fabregate-Fuente
authors.forename: Juan
authors.initials: J
authors.lastname: Álvarez-Linera
authors.forename: Inmaculada
authors.initials: I
authors.lastname: De Prada-Vicente
authors.forename: Marcelo
authors.initials: M
authors.lastname: Budke
authors.forename: María-Luz
authors.initials: ML
authors.lastname: Ruiz-Falcó
authors.forename: María-Ángeles
authors.initials: MÁ
authors.lastname: Pérez-Jiménez
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000367:Age Factors; D054022:Cerebrum / Q000254:growth & development* / Q000473:pathology; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D004827:Epilepsy / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D038421:Hemispherectomy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009473:Neuronal Plasticity; D009483:Neuropsychological Tests; D020127:Recovery of Function; D012640:Seizures / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome