Comparative Analysis of Hemispherotomy in Adults versus Children- A Prospective Observational Series.
Journal
Neurology India
ISSN: 1998-4022
Titre abrégé: Neurol India
Pays: India
ID NLM: 0042005
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
received:
12
03
2020
accepted:
06
06
2020
medline:
6
3
2024
pubmed:
6
3
2024
entrez:
5
3
2024
Statut:
ppublish
Résumé
Hemispherotomy (HS) is an effective treatment for unilateral hemispheric onset epilepsy. There are few publications for HS in adults, and there is no series comparing adults and pediatric patients of HS. To compare the hemispherotomies done in adult patients with pediatric ones in terms of efficacy and safety. Data was prospectively collected for HS patients (up to 18 years and more) from Aug 2014 to Aug 2018. Comparison between the groups was made for seizure onset, duration of epilepsy, frequency of seizures, number of drugs, intraoperative blood loss, postoperative seizure control, postoperative stay, postoperative motor functions, and preoperative and postoperative intelligence quotient. Follow-up was one year. A total of 61 pediatric and 11 adults underwent HS. The seizure onset was earlier in children, and the duration of epilepsy was longer in adults. The frequency of seizures per day was more in children being 14.62 ± 26.34 in children, and 7.71 ± 5.21 per day in adults (P - 0.49). The mean number of drugs was similar in the preoperative and postoperative periods in both. Class I seizure outcome was similar in both the groups being 85.24% in children and 90.9% in adults (P - 0.56). Blood loss, postoperative stay, was similar in both the groups. No patient had a new permanent motor deficit. Power worsened transiently in 1 pediatric patient and in 4 adult patients. The visual word reading and object naming improved in both the groups (no intergroup difference), and IQ remained the same in both groups. One adult patient had meningitis, and another had hydrocephalus requiring shunt placement. Hemispherotomy is a safe and effective procedure in adults as in children in appropriately selected patients.
Sections du résumé
BACKGROUND
BACKGROUND
Hemispherotomy (HS) is an effective treatment for unilateral hemispheric onset epilepsy. There are few publications for HS in adults, and there is no series comparing adults and pediatric patients of HS.
OBJECTIVE
OBJECTIVE
To compare the hemispherotomies done in adult patients with pediatric ones in terms of efficacy and safety.
METHODS
METHODS
Data was prospectively collected for HS patients (up to 18 years and more) from Aug 2014 to Aug 2018. Comparison between the groups was made for seizure onset, duration of epilepsy, frequency of seizures, number of drugs, intraoperative blood loss, postoperative seizure control, postoperative stay, postoperative motor functions, and preoperative and postoperative intelligence quotient. Follow-up was one year.
RESULTS
RESULTS
A total of 61 pediatric and 11 adults underwent HS. The seizure onset was earlier in children, and the duration of epilepsy was longer in adults. The frequency of seizures per day was more in children being 14.62 ± 26.34 in children, and 7.71 ± 5.21 per day in adults (P - 0.49). The mean number of drugs was similar in the preoperative and postoperative periods in both. Class I seizure outcome was similar in both the groups being 85.24% in children and 90.9% in adults (P - 0.56). Blood loss, postoperative stay, was similar in both the groups. No patient had a new permanent motor deficit. Power worsened transiently in 1 pediatric patient and in 4 adult patients. The visual word reading and object naming improved in both the groups (no intergroup difference), and IQ remained the same in both groups. One adult patient had meningitis, and another had hydrocephalus requiring shunt placement.
CONCLUSION
CONCLUSIONS
Hemispherotomy is a safe and effective procedure in adults as in children in appropriately selected patients.
Identifiants
pubmed: 38443004
doi: 10.4103/neuroindia.NI_299_20
pii: 02223311-202472010-00014
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
69-73Informations de copyright
Copyright © 2024 Copyright: © 2024 Neurology India, Neurological Society of India.
Références
Dwivedi R, Ramanujam B, Chandra PS, Sapra S, Gulati S, Kalaivani M, et al. Surgery for drug-resistant epilepsy in children. N Engl J Med 2017;377:1639–47
Delalande O, Bulteau C, Dellatolas G, Fohlen M, Jalin C, Buret V, et al. Vertical parasagittal hemispherotomy: Surgical procedures and clinical long-term outcomes in a population of 83 children. Neurosurgery 2007;60:ONS19–32. discussion ONS32
Villemure JG, Mascott CR. Peri-insular hemispherotomy: Surgical principles and anatomy. Neurosurgery 1995;37:975–81
Holloway V, Gadian DG, Vargha-Khadem F, Porter DA, Boyd SG, Connelly A. The reorganization of sensorimotor function in children after hemispherectomy. A functional MRI and somatosensory evoked potential study. Brain J Neurol 2000;123 Pt 12:2432–44
Berg AT. Understanding the delay before epilepsy surgery: Who develops intractable focal epilepsy and when?. CNS Spectr 2004;9:136–44
Shen A, Quaid KT, Porter BE. Delay in pediatric epilepsy surgery: A caregiver's perspective. Epilepsy Behav EB 2018;78:175–8
Benbadis S, Vale F, Dubeau F, Duchowny M. Huh?Hemispherectomy in adults?: An exercise in risk-benefit analysis. Epileptic Disord Int Epilepsy J Videotape 2009;11:258–9
Devlin AM, Cross JH, Harkness W, Chong WK, Harding B, Vargha-Khadem F, et al. Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain J Neurol 2003;126:556–66
Kim J, Park E-K, Shim K-W, Kim DS. Hemispherotomy and functional hemispherectomy: Indications and outcomes. J Epilepsy Res 2018;8:1–5
McGovern RA, N V Moosa A, Jehi L, Busch R, Ferguson L, Gupta A, et al. Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients. Epilepsia 2019;60:2416–27
Cukiert A, Cukiert CM, Argentoni M, Baise-Zung C, Forster CR, Mello VA, et al. Outcome after hemispherectomy in hemiplegic adult patients with refractory epilepsy associated with early middle cerebral artery infarcts. Epilepsia 2009;50:1381–4
Schusse CM, Smith K, Drees C. Outcomes after hemispherectomy in adult patients with intractable epilepsy: Institutional experience and systematic review of the literature. J Neurosurg 2018;128:853–61
McClelland S, Maxwell RE. Hemispherectomy for intractable epilepsy in adults: The first reported series. Ann Neurol 2007;61:372–6
Kwan P, Brodie MJ. Definition of refractory epilepsy: Defining the indefinable?. Lancet Neurol 2010;9:27–9
Chandra PS, Kurwale N, Garg A, Dwivedi R, Malviya SV, Tripathi M. Endoscopy-assisted interhemispheric transcallosal hemispherotomy: Preliminary description of a novel technique. Neurosurgery 2015;76:485–94. discussion 494-5
Granata T, Matricardi S, Ragona F, Freri E, Casazza M, Villani F, et al. Hemispherotomy in Rasmussen encephalitis: Long-term outcome in an Italian series of 16 patients. Epilepsy Res 2014;108:1106–19
Chandra PS, Subianto H, Bajaj J, Girishan S, Doddamani R, Ramanujam B, et al. Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: A comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome. J Neurosurg Pediatr 2018;23:187–97
Girishan S, Tripathi M, Garg A, Doddamani R, Bajaj J, Ramanujam B, et al. Enhancing outcomes of endoscopic vertical approach hemispherotomy: Understanding the role of “temporal stem”residual connections causing recurrence of seizures. J Neurosurg Pediatr 2019:1–9. doi: 10.3171/2019.8.PEDS19148
doi: 10.3171/2019.8.PEDS19148
Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, et al. ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 2001;42:282–6
Kaur H, Bajpai S, Pershad D, Sreenivas V, Nehra A. Development and standardization of Indian aphasia battery. J Ment Health Hum Behav 2017;22:116–22
Cohen J. A power primer. Psychol Bull 1992;112:155–9
Nayak R, Mathew V, Rajgopal R, Raju K. Hemispherotomy for late post-traumatic super-refractory status epilepticus in an adult. Epilepsy Behav Case Rep 2017;8:114–6
Chandra SP, Tripathi M. Endoscopic epilepsy surgery: Emergence of a new procedure. Neurol India 2015;63:571–82
Garcia-Garcia S, Kakaizada S, Oleaga L, Benet A, Rincon-Toroella J, González-Sánchez JJ. Presurgical simulation for neuroendoscopic procedures: Virtual study of the integrity of neurological pathways using diffusion tensor imaging tractography. Neurol India 2019;67:763–9
Liang S, Zhang G, Li Y, Ding C, Yu T, Wang X, et al. Hemispherectomy in adults patients with severe unilateral epilepsy and hemiplegia. Epilepsy Res 2013;106:257–63
Schramm J, Delev D, Wagner J, Elger CE, von Lehe M. Seizure outcome, functional outcome, and quality of life after hemispherectomy in adults. Acta Neurochir (Wien) 2012;154:1603–12
Loddenkemper T, Dinner DS, Kubu C, Prayson R, Bingaman W, Dagirmanjian A, et al. Aphasia after hemispherectomy in an adult with early onset epilepsy and hemiplegia. J Neurol Neurosurg Psychiatry 2004;75:149–51
Marras CE, Granata T, Franzini A, Freri E, Villani F, Casazza M, et al. Hemispherotomy and functional hemispherectomy: Indications and outcome. Epilepsy Res 2010;89:104–12
Bajaj J, Chandra SP, Ramanujam B, Girishan S, Doddamani R, Tripathi M. Need of immediate drug reduction after epilepsy surgery - A prospective observational study. Neurol India 2019;67:1050–3
Lettori D, Battaglia D, Sacco A, Veredice C, Chieffo D, Massimi L, et al. Early hemispherectomy in catastrophic epilepsy: A neuro-cognitive and epileptic long-term follow-up. Seizure 2008;17:49–63
Gröppel G, Dorfer C, Mühlebner-Fahrngruber A, Dressler A, Porsche B, Czech T, et al. Improvement of language development after successful hemispherotomy. Seizure 2015;30:70–5