title: Hemispherotomy for isolated infantile spasms following perinatal ischemic stroke.
abstract: BACKGROUND
  Infantile spasms (IS) are a severe epileptic encephalopathy. In patients with early focal ischemia and refractory IS, a preoperative evaluation is required even if IS are the only ictal manifestation.
  
  
  METHODS
  We report three such patients who presented with IS between 5 and 7 months of age without any other focal seizure types. Imaging exhibited a perinatal middle cerebral artery (MCA) stroke.
  
  
  RESULTS
  All patients had hemiparesis and experienced psychomotor regression after the onset of IS. Scalp video-electroencephalogram (EEG) monitoring for presurgical assessment showed interictal and ictal EEG characteristics between the pathological and the healthy hemisphere and surgery was proposed despite the lack of any focal seizures. The three patients underwent hemispherotomy at a mean age of 27 months and became seizure-free without medication (follow-up 49-144 months). The two patients who underwent early hemispherotomy acquired normal verbal intelligence, whereas the third, operated on at 38 months of age, remained with severe mental retardation.
  
  
  CONCLUSIONS
  Early hemispherotomy in drug-resistant epilepsy related to a perinatal MCA may cure the seizures even if the patient has IS as sole type and prevent mental retardation in some children.
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France. Electronic address: dtaussig@fo-rothschild.fr.
authors.forename: Delphine
authors.initials: D
authors.lastname: Taussig
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France; Inserm U1129, "Infantile Epilepsies and Brain Plasticity" Paris, France; PRES, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France.
authors.forename: Georg
authors.initials: G
authors.lastname: Dorfmüller
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France; Inserm U1129, "Infantile Epilepsies and Brain Plasticity" Paris, France; PRES, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France.
authors.forename: Jessica
authors.initials: J
authors.lastname: Save
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Fohlen
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Chipaux
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ferrand-Sorbets
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Delalande
authors.affiliation: Fondation Ophtalmologique A. de Rothschild, Pediatric Neurosurgery Department, 75019 Paris, France; Inserm U1129, "Infantile Epilepsies and Brain Plasticity" Paris, France; PRES, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Bulteau
mesh_terms: D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D020244:Infarction, Middle Cerebral Artery / Q000150:complications*; D008297:Male; D013036:Spasms, Infantile / Q000209:etiology / Q000601:surgery*
keywords: EEG-video monitoring; Hemispherotomy; Infantile spasms; Middle cerebral artery stroke; Neuropsychology