title: Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients.
abstract: OBJECTIVE
  Hemispheric neurosurgery is an established treatment for severe epilepsy caused by extended unilateral brain pathology. However, it is still an unresolved question at which age surgery should best be performed. In light of decreasing plasticity and the cumulative impact of seizures and anticonvulsants on neurodevelopment, early surgery appears preferable.
  
  
  METHODS
  We retrospectively investigated the medical, cognitive-behavioural and psychosocial long-term outcome (follow-up: 9.4 years (1.1-19.4)) of hemispherectomy as a function of age at surgery (early: <7 years/intermediate: 7-16 years/late: >16 years) based on a structured postal survey in a large patient sample (N=61/81, return rate: 75%).
  
  
  RESULTS
  At follow-up, 45 (74%) patients were seizure free. Presurgical levels of intelligence were below average in most patients (79%) and postsurgical cognition largely resembled the presurgical capacities. Best seizure outcome was obtained for early surgery patients (90% seizure free). Patients with late surgery, however, exhibited higher presurgical and postsurgical intelligence and better psychosocial achievements. Binary logistic regression identified better presurgical intelligence and higher age at surgery as positive predictors of postsurgical intelligence. Lower presurgical intelligence and postsurgical seizure freedom predicted intellectual pre-post improvements.
  
  
  CONCLUSIONS
  Our data confirm the efficacy and cognitive safety of hemispheric surgeries performed at different ages. Eligible older and high functioning patients can be perfect candidates. Presurgical intelligence serves as indicator of the functional integrity of the contralateral hemisphere, which mainly determines postsurgical cognition and psychosocial outcome. Seizure freedom promotes cognitive improvement. As many unknown factors determined age at surgery, our retrospective data neither question early surgeries nor suggest postponing surgery.
authors.affiliation: Department of Epileptology, University of Bonn Medical Centre, Sigmund-Freud Str. 25, 53105 Bonn, Germany. anita.althausen@ukb.uni-bonn.de
authors.forename: Anita
authors.initials: A
authors.lastname: Althausen
authors.forename: Ulrike
authors.initials: U
authors.lastname: Gleissner
authors.forename: Christian
authors.initials: C
authors.lastname: Hoppe
authors.forename: Robert
authors.initials: R
authors.lastname: Sassen
authors.forename: Svenja
authors.initials: S
authors.lastname: Buddewig
authors.forename: Marec
authors.initials: M
authors.lastname: von Lehe
authors.forename: Johannes
authors.initials: J
authors.lastname: Schramm
authors.forename: Christian Erich
authors.initials: CE
authors.lastname: Elger
authors.forename: Christoph
authors.initials: C
authors.lastname: Helmstaedter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001519:Behavior; D001921:Brain / Q000601:surgery*; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000523:psychology; D011237:Predictive Value of Tests; D012640:Seizures / Q000601:surgery; D012919:Social Behavior; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult