Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients.
epilepsy surgery
hemispherectomy in adults
outcomes
refractory epilepsy
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
03
05
2019
revised:
09
10
2019
accepted:
10
10
2019
pubmed:
5
11
2019
medline:
16
4
2020
entrez:
3
11
2019
Statut:
ppublish
Résumé
To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents. We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed. Thirty-six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow-up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6-month follow-up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes. Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.
Identifiants
pubmed: 31677151
doi: 10.1111/epi.16378
pmc: PMC6911022
mid: NIHMS1054830
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2416-2427Subventions
Organisme : NINDS NIH HHS
ID : R01 NS097719
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Wiley Periodicals, Inc. © 2019 International League Against Epilepsy.
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