Discordant electroencephalogram epileptiform activity and hemispherectomy in children with refractory epilepsy and encephaloclastic lesions: a case series

Abstract

This is a case series of six children with unilateral cerebral palsy and hemispheric encephaloclastic lesions who were evaluated for epilepsy surgery. Seizure onset was in the neonatal period in three children, at 17 months in two, and at 5 years in one. Their ictal and interictal electroencephalogram (EEG) abnormalities showed paradoxical lateralization to the incorrect/ 'normal' hemisphere or showed bilateral abnormalities. After cautious discussion regarding the discordant electroclinical profile and implications for outcome, they proceeded to a functional hemispherectomy (between ages 4-11y) with good outcomes (at 1-10y follow-up). Their clinical details, EEG findings, electrocorticography, neuroimaging, and histology are reported. Possible surgical candidacy should be evaluated early in children with refractory epilepsy, even those with complex profiles and discordant data from the different investigations. Contralateral or bilateral EEG abnormalities should not preclude consideration of hemispherectomy in children with refractory epilepsy, hemiparesis, and uniclastic lesions.

Adult hemiconvulsive hemiatrophy syndrome: a novel clinicoradiologic disorder in adults

“…Finally, it is significant that all of our patients developed recurrent seizures after a delay of 3 to 6 months despite being alcohol‐free. This is the same in the paediatric HHE syndrome, which paradoxically shows a good response to hemispherectomy for resistant epilepsy despite seizure foci being recorded in both cortices 16 …”

Epilepsy in Cerebral Palsy: A Brief Narrative Review

“…Patients with focal or unilateral lesions, however, may do very well with epilepsy surgery. In a case series of 6 children with unilateral cerebral palsy and hemispheric encephaloclastic lesions who were treated with hemispherectomy, all children had an Engel Class 1 outcome for seizures with an improvement in cognition, quality of life, a reduction in anti-seizure medications [45]. Epilepsy surgery, however, can negatively impact language, motor and neurocognitive functions.…”

Children with contralateral or bilateral electroencephalogram epileptiform activity should not be excluded from hemispherectomy

“…The present case series 2 is important in that it reminds us that we must be careful when we evaluate possible hemispherectomy candidates with EEG abnormalities contralateral to the structural findings and consider the aetiology and structural findings to be the most important. Sometimes you must ignore EEG findings, supported by the structural analysis and with that, the child can undergo a procedure with a high chance of seizure freedom 1,5 or at least a substantial reduction of the frequency of seizures.…”

“…The selection of the child that would benefit from such a procedure is crucial. Nagarajan et al 2 . give an important message regarding the selection of children for a hemispherectomy.…”

“…The selection of the child that would benefit from such a procedure is crucial. Nagarajan et al 2 give an important message regarding the selection of children for a hemispherectomy. The basic concept has been presented earlier 3 and this case series certainly supports those earlier statements.…”