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Melikyan A.G.
Burdenko Neurosurgical Center
Kozlova A.B.
Burdenko Neurosurgical Center
Vlasov P.A.
Burdenko Neurosurgical Center
Shishkina L.V.
Burdenko Neurosurgical Center
Demin M.O.
Burdenko Neurosurgical Center
Shults E.I.
Burdenko Neurosurgical Center
Buklina S.B.
Burdenko Neurosurgical Center
Nagorskaya I.A.
Burdenko Neurosurgical Center
Lessons learnt from 101 hemispherotomies in children with symptomatic epilepsy. Part I: seizure outcome
Journal: Burdenko's Journal of Neurosurgery. 2021;85(5): 15‑21
Read: 2735 times
To cite this article:
Melikyan AG, Kozlova AB, Vlasov PA, et al. . Lessons learnt from 101 hemispherotomies in children with symptomatic epilepsy. Part I: seizure outcome. Burdenko's Journal of Neurosurgery.
2021;85(5):15‑21. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20218505115
To evaluate variables that may predict the outcome after hemispherotomy basing on a retrospective study of a large consecutive pediatric cohort of patients from a single institution.
One hundred and one patients with refractory seizures and variable decline in development (n=78) underwent hemispherotomy (med. age – 43 months, med. epilepsy history - 30 months). Developmental pathology was the anatomical substrate of disorder in 42 patients, while the infantile post-stroke scarring and gliosis was its origin in the majority of 43 cases with acquired etiology. The progressive pathology (the Rasmussen encephalitis, Sturge-Weber angiomatosis and tuberous sclerosis) was the etiology in 16 children. Left-sided hemisphere was impaired in 54 cases; some contralateral anatomical and potentially epileptogenic MRI-abnormalities were noted also in «healthy» hemisphere in ¼ of all cases. Eight patients needed second surgery to complete sectioning of undercut commissural fibers. FU is known in 91 patients (med. — 1.5 years) and 73 of them were free of seizures (80.2%), but only 30 of 40 patients with FU > 2 years were still SF (75%). All but one of re-do hemispherotomies were successful. AED-treatment was discontinued in 46 cases and tapered in other 27 patients. Up to 90% of kids demonstrated some improvement in behavior and cognition.
Developmental pathology, infantile spasms and younger age onset of seizures are negative predictors for achievement of SF-status (p<0.05). Neither bilateral epileptic EEG-signs, nor MRI-abnormalities in «healthy» hemisphere had any relation to outcome, but focal seizure onset was associated positively with further SF-status (p = 0.03). Kids with multiple lobe unilateral CD do somewhat worse than their counterparts with hemimegalencephaly and acquired etiology. Post-hemispherotomy hemiparesis (either new or worsening of already existed one) has no relation either to the age at surgery, or to the age onset (p = 0.41). Children with left-sided lesions were less successful in every neurodevelopmental domain except maintaining expressive language. Patients with relapse or persisting seizures have good chances to become SF by re-doing hemispherotomy and should be evaluated for the possibly incomplete hemispheric isolation.
Authors:
Melikyan A.G.
Burdenko Neurosurgical Center
Kozlova A.B.
Burdenko Neurosurgical Center
Vlasov P.A.
Burdenko Neurosurgical Center
Shishkina L.V.
Burdenko Neurosurgical Center
Demin M.O.
Burdenko Neurosurgical Center
Shults E.I.
Burdenko Neurosurgical Center
Buklina S.B.
Burdenko Neurosurgical Center
Nagorskaya I.A.
Burdenko Neurosurgical Center
Received:
27.04.2021
Accepted:
05.08.2021
List of references:
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