title: Improvement of language development after successful hemispherotomy.
abstract: OBJECTIVE
  To investigate language development after functional hemispherotomy and to evaluate prognostic factors for (un-)favourable outcomes.
  
  
  METHODS
  Children and adolescents who had vertical perithalamic hemispherotomy at the Medical University Wien (MUW) paediatric epilepsy centre were identified from a prospectively maintained database. Inclusion criteria were: complete clinical, neurophysiological and neuropsychological data, seizure freedom and a minimum follow-up of 12 months after surgery. The language quotients (LQ) prior to surgery and at last follow-up were calculated for each child. In addition, associations between pre- to post-surgical changes in LQ and the following variables were examined: age at epilepsy-onset, age at surgery and duration of epilepsy prior to surgery, aetiology, side of surgery, interictal EEG including sleep organization before and 12 months after surgery and antiepileptic-drug (AED) withdrawal state at last follow-up. Analyses were carried out in SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Nonparametric Wilcoxon and chi-square tests were applied, as required.
  
  
  RESULTS
  Data from 28 children (14 female) were analyzed. The median age at epilepsy surgery was 64.5 months. The median follow-up after surgery was 3.0 years (±2.6 years, range 12 months to 12 years). Significant gains in LQs at last follow-up were found in 31% of the children (p=0.008). Short disease duration prior to surgery, acquired pathology, lack of epileptiform EEG discharges in the contralateral hemisphere and/or normalization of EEG sleep patterns after surgery, and successful AED withdrawal were linked to favourable language outcomes.
  
  
  CONCLUSIONS
  Successful and early hemispherotomy results in improvement of language function in the intact hemisphere.
authors.affiliation: Epilepsy Monitoring Unit, Department of Pediatrics and Adolescence Medicine, MUW/AKH Vienna, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Gröppel
authors.affiliation: Department of Neurosurgery, MUW/AKH Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Dorfer
authors.affiliation: Epilepsy Monitoring Unit, Department of Pediatrics and Adolescence Medicine, MUW/AKH Vienna, Austria.
authors.forename: Angelika
authors.initials: A
authors.lastname: Mühlebner-Fahrngruber
authors.affiliation: Epilepsy Monitoring Unit, Department of Pediatrics and Adolescence Medicine, MUW/AKH Vienna, Austria.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dressler
authors.affiliation: Epilepsy Monitoring Unit, Department of Pediatrics and Adolescence Medicine, MUW/AKH Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Porsche
authors.affiliation: Department of Neurosurgery, MUW/AKH Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Czech
authors.affiliation: Epilepsy Monitoring Unit, Department of Pediatrics and Adolescence Medicine, MUW/AKH Vienna, Austria. Electronic address: martha.feucht@meduniwien.ac.at.
authors.forename: Martha
authors.initials: M
authors.lastname: Feucht
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001921:Brain / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000209:etiology / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D038421:Hemispherectomy; D006801:Humans; D007223:Infant; D007804:Language Development; D007807:Language Tests; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome
keywords: Children; Epilepsy surgery; Language developmental