title: Hemispheric surgery for refractory epilepsy in children and adolescents: outcome regarding seizures, motor skills and adaptive function.
abstract: OBJECTIVE
  The aim of the study was to report the seizure outcome, motor skills and adaptive motor functions in a series of children and adolescents who underwent hemispheric surgery, analysing the risk-benefits of surgery.
  
  
  METHODS
  The clinical course, seizure and motor function outcomes of 15 patients who underwent hemispheric surgery were reviewed.
  
  
  RESULTS
  The mean age at surgery was 9.5, with 1-9 years follow-up. The underlying pathologies were Rasmussen encephalitis, vascular disorders, and hemimegalencephaly. All the patients presented with severe epilepsy and different degrees of hemiparesis, although motor functionality was preserved in 80% of the patients. At last follow-up, 67% were seizure free, and 20% rarely experienced seizures. Antiepileptic drugs were reduced in 60%, and complete withdrawal from such drugs was successful in 20% of the patients. The motor outcome following the surgery varied between the patients. Despite the motor deficit after surgery, the post-operative motor function showed unchanged for gross motor function in most (60%), while 27% improved. Similar results were obtained for the ability to handle objects in daily life activities. Sixty percent of the children were capable of handling objects, with somewhat reduced coordination and/or motor speed.
  
  
  CONCLUSIONS
  Pre-surgical motor function continues to play a role in the pre-surgical evaluation process in order to provide a baseline for outcome. Hemispheric surgery, once regarded as a radical intervention and last treatment resource, may become routinely indicated for refractory hemispheric epilepsy in children and adolescents, with oftentime favourable motor outcomes.
authors.affiliation: Departamento de Neurologia e Neurocirurgia, Hospital São Paulo, Universidade Federal de São Paulo, Rua Napoleão de Barros, 865, Vila Clementino, São Paulo, SP, Brazil. Electronic address: anahamad@gmail.com.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Hamad
authors.forename: Luís Otávio
authors.initials: LO
authors.lastname: Caboclo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Centeno
authors.forename: Livia Vianez
authors.initials: LV
authors.lastname: Costa
authors.forename: Carol
authors.initials: C
authors.lastname: Ladeia-Frota
authors.forename: Henrique Carrete
authors.initials: HC
authors.lastname: Junior
authors.forename: Nicolas Garofalo
authors.initials: NG
authors.lastname: Gomez
authors.forename: Murilo
authors.initials: M
authors.lastname: Marinho
authors.forename: Elza Márcia Targas
authors.initials: EM
authors.lastname: Yacubian
authors.forename: Américo Ceiki
authors.initials: AC
authors.lastname: Sakamoto
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000293:Adolescent; D002648:Child; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000523:psychology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D008297:Male; D019957:Motor Skills Disorders / Q000209:etiology*; D009483:Neuropsychological Tests; D010290:Parents / Q000523:psychology; D016896:Treatment Outcome
keywords: Children; Epilepsy; Follow-up; Hemispheric surgery; Impairment; Motor function; Outcome