Determinants of Functional Outcome after Pediatric Hemispherotomy

Abstract

ObjectiveWe aimed to evaluate determinants of functional outcome after pediatric hemispherotomy in a large and recent multicenter cohort.MethodsWe retrospectively investigated the functional outcomes of 455 children who underwent hemispherotomy in five epilepsy centers in 2000–2016. We identified determinants of unaided walking, voluntary grasping with the hemiplegic hand, and speaking through Bayesian multivariable regression modeling using missing data imputation.Results75% of children were seizure‐free, and 44% stopped antiseizure medication at a 5.1‐year mean follow‐up (range 1–17.1). 77% of children could walk unaided, 8% could grasp voluntarily, and 68% could speak at the last follow‐up. Children were unlikely to walk when they had contralateral MRI abnormalities (40/73; p = 0.04), recurrent seizures following hemispherotomy (62/109; p = 0.04), and moderately (50/61; p = 0.03) or severely impaired (127/199; p = 0.001) postsurgical intellectual functioning, but were likely to walk when they were older at outcome determination (p = 0.01). Children were unlikely to grasp voluntarily with the hand contralateral to surgery when they had Rasmussen encephalitis (0/61; p = 0.001) or Sturge–Weber syndrome (0/32; p = 0.007). Children were unlikely to speak when they had contralateral MRI abnormalities (30/69; p = 0.002) and longer epilepsy duration (p = 0.01), but likely to speak when they had Sturge–Weber syndrome (29/35; p = 0.01), were older at surgery (p = 0.04) and older at outcome determination (p < 0.001).InterpretationEtiology and bilaterality of structural brain abnormalities were key determinants of functional outcome after hemispherotomy. Longer epilepsy duration affected language outcomes. Not surprisingly, walking and talking ability increased with older age at outcome evaluation.This article is protected by copyright. All rights reserved.

Lesion volume and spike frequency on EEG impact perfusion values in focal cortical dysplasia: a pediatric arterial spin labeling study

“…It should be noted that FCD-related perfusion changes were detectable on ASL despite sedation in half of our cohort, in contrast with the only previous study focusing on ASL in FCD-related epilepsy, which considered exclusively scans performed without sedation 30 . This observation is encouraging, considering the young age at epilepsy onset and the impaired cognitive functioning in children undergoing presurgical evaluation 11 , 13 – 15 , 34 – 38 —and requiring sedation for MRI acquisition—along with the benefits of early referral and, if indicated, early surgical intervention in this vulnerable population 16 .…”

“…We included children and adolescents who underwent brain MRI between January 2017 and March 2023 at the University Children’s Hospital Zurich, according to our dedicated epilepsy protocol 10 , 15 , 34 , 36 , 53 – 55 . The inclusion criteria were: (1) age ≤ 19 years at the time of the MRI, (2) diagnosis of focal structural epilepsy, according to seizure semiology, EEG, and MRI findings, (3) diagnosis of FCD according to radiological criteria 56 , 57 , corroborated by histopathology in surgical cases 58 , (4) no history of prior resective epilepsy surgery, and (5) availability of ASL MRI sequences.…”

“…Malformations of cortical development and, specifically, focal cortical dysplasia (FCD) 4 constitute the most common substrate of paediatric focal lesional epilepsy 5 . Epilepsy surgery is a safe and effective treatment option for carefully selected children with FCD-associated epilepsy 6 – 11 and can potentially offer a cure, i.e., seizure freedom in the absence of antiseizure medication (ASM) 12 , and thus positively impact developmental and cognitive functioning 13 – 15 . Presurgical evaluation aims to localise the lesion primarily responsible for seizure onset, delineate the epileptogenic zone, and demarcate the eloquent functional regions 12 .…”

Reader Response: Comparison of Hemispheric Surgery Techniques for Pediatric Drug-Resistant Epilepsy: An Individual Patient Data Meta-Analysis

“…Our multicentric study based on a recent pediatric cohort (n = 457) was conducted between 2000 and 2016 in European centers. 4,5 We applied multivariable regression analysis, subgroup matching for significant covariate differences, and Bayesian analysis. We found comparable overall major complication rates for the 2 approaches and no evidence of an impact of surgical technique on long-term seizure outcomes.…”