Five-Year Long-Term Prognosis of Epileptic Children After Hemispheric Surgery

Cao, Kai; Liu, Meiling; Wang, Chao; Liu, Qingrong; Yang, Kun; Tao, Lixin; Guo, Xiaoxia

doi:10.1097/md.0000000000003743

Cited by 9 publications

(3 citation statements)

References 40 publications

(25 reference statements)

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“…However, these procedures often result in substantial visual field defects, such as homonymous hemianopia, in which the contralateral visual field is lost on the same side of both eyes. In a recent systemic review, it was found that 5 years after hemispherectomy surgery, 71% of children were seizure-free (2); however, the optimal timing of surgery, depending on age of presentation and effect of underlying pathology, is still very unclear. Furthermore, although the immature brain may be expected to compensate for impaired function if surgery is performed early (3), there has been little definitive research to determine the long-term functional effects of resulting visual field defects (4).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Patient-Reported Outcomes of Visual Field Defects and Compensatory Mechanisms in Patients After Cerebral Hemispherectomy

Meer¹,

Chen²,

Jones³

et al. 2020

Journal of Neuro-Ophthalmology

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Background: In cases of intractable epilepsy resistant to drug therapy, hemispherectomy is often the only treatment option to mitigate seizures; however, the true long-term subjective visual outcomes are relatively unexplored. In this study, we sought to determine and characterize patientreported visual function years after hemispherectomy. Methods: This was an observational study conducted on a large cohort of children with seizure disorder treated with cerebral hemispherectomy. An online survey was sent to parents with questions to assess subjective visual function with a variety of questions from presence of visual field defects after hemispherectomy, to improvement over time, compensatory mechanisms used, and development of strabismus. Results: This survey was emailed to 248 parents of previously evaluated children who agreed to be re-surveyed, 48 (20%) of which responded. The average age at hemispherectomy was approximately 5 (±4) years, and the average time after hemispherectomy was 7 (±5) years. Thirty-nine patients (81%) were seizure-free after 1 surgery and 85% (n = 41) were seizure-free after $1 surgeries. Thirty-four (71%) experienced a visual field defect after surgery, but 25 (52%) experienced subjective improvement over time. Thirty-eight (79%) used compensatory mechanisms, such as head tilting, with 16 (33%) patients experiencing subjective improvement over time. Twenty-seven (56%) patients experienced a decrease in visual acuity after surgery with 12 (25%) experiencing subjective improvement over time. Conclusion: In a large cohort examining patient-reported visual outcomes years after hemispherectomy, most patients experienced strabismus and/or visual field defects. However, more than half reported improvements and compensatory mechanisms (exotropic strabismus and ipsilateral esotropic strabismus) over time, presumably to enhance visual field function. By exploring subjective visual and cognitive function, this paper uniquely characterizes patient-reported improvements over time, and provides motivation for larger longitudinal studies using more quantitative measures of visual function and improvement after hemispherectomy.

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Section: Introductionmentioning

confidence: 99%

Long-Term Patient-Reported Outcomes of Visual Field Defects and Compensatory Mechanisms in Patients After Cerebral Hemispherectomy

Meer¹,

Chen²,

Jones³

et al. 2020

Journal of Neuro-Ophthalmology

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“…This modification led to a reduction in complications, and variations of this procedure are most commonly used today; however, anatomical hemispherectomy is still in use. 1 –5…”

mentioning

confidence: 99%

“…Posthemispherectomy, reported long-term (more than 5 years’) seizure-free success rates range from 56% to 75%. 2 –7…”

mentioning

confidence: 99%

Etiology and Age Modifies Subjective Visual Function After Cerebral Hemispherectomy

et al. 2019

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Background: Cerebral hemispherectomy is typically used to treat patients with pharmacoresistant epilepsy. Visual-related outcomes are relatively unstudied in this population, aside from the knowledge that patients develop a complete homonymous hemianopia contralateral to the side of the hemispherectomy. The purpose of this study was to determine and characterize parent-reported functional visual, oculomotor, and postural changes in a large population of patients following cerebral hemispherectomy. Methods: An online survey was sent to parents of children who had undergone hemispherectomy for seizure control. Families were recruited by the Brain Recovery Project: Childhood Epilepsy Surgery Foundation. Parent-reported subjective visual function was assessed by the presence of peripheral field defects, ocular misalignment and anomalous head posture. Results: A total of 196 (12.5%) participants responded. Postoperative follow-up was 92±78 months (range: 1-382). Ninety-three percent of parents reported the child had difficulties with peripheral vision. Torticollis was present postoperatively in 122 (62%) patients. Strabismus was noted in 93 (49%). Fifty-five (59%) of the strabismus patients demonstrated exotropia with the majority of exotropia patients demonstrating the exo-deviated eye in the direction contralateral to the hemispherectomy (74.5%). Both torticollis and strabismus were most frequently seen immediately after surgery. Sixty-six patients (34%) underwent strabismus treatment. Patients with younger age of seizure onset, younger age of surgery, and certain epilepsy etiologies (hemimegencephaly, Sturge-Weber syndrome) were more likely to develop strabismus and torticollis. Conclusions: Torticollis and strabismus are common after hemispherectomy and appear to be influenced by etiology and age at surgery. Preoperative discussion with parents and patients regarding those compensatory mechanisms is recommended, and postoperative ophthalmologic assessments are also encouraged.

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Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a systematic review

Pur,

Sivakumar,

Bursztyn

et al. 2023

Canadian Journal of Ophthalmology

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Five-Year Long-Term Prognosis of Epileptic Children After Hemispheric Surgery

Cited by 9 publications

References 40 publications

Long-Term Patient-Reported Outcomes of Visual Field Defects and Compensatory Mechanisms in Patients After Cerebral Hemispherectomy

Long-Term Patient-Reported Outcomes of Visual Field Defects and Compensatory Mechanisms in Patients After Cerebral Hemispherectomy

Etiology and Age Modifies Subjective Visual Function After Cerebral Hemispherectomy

Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a systematic review

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