Hemispherectomy for intractable unihemispheric epilepsy Etiology vs outcome

Kossoff, Eric H.; Vining, Eileen P.G.; Pillas, Diana J.; Pyzik, Paula L.; Avellino, Anthony M.; Carson, Benjamin S.; Freeman, John M.

doi:10.1212/01.wnl.0000090107.04681.5b

Cited by 202 publications

(170 citation statements)

References 13 publications

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“…Patients suffering from acquired and progressive condi- tions generally do better than patients with developmental disorders, 11,18,19,21 and this observation is supported by the findings of the present study. Due to the small number of available studies for anatomical hemispherectomy and hemidecortication, seizure outcome for different etiologies dependent on the type of hemispherectomy was only feasible for hemispherotomy and functional hemispherectomy.…”

Section: 2741supporting

confidence: 89%

“…The overall rate of seizure freedom was 73.4%, which is slightly higher than the rate of seizure freedom found by Holthausen et al 15 and comparable to other large, more recent series. 6,9,19,25,27,32,43 Long-term sustainability of seizure freedom is absolutely critical to justify surgery for epilepsy, which is (7) 10 (71) 2 (14) Sugimoto et al, 1999 1991-1996 Hospital for Sick Children Epilepsia (14) 33 (30) 51 (46) (continued) (27) 16 (33) 8 ( (44) 20 (21) 19 ( (42) 63 (34) 28 ( an irreversible intervention. Long-term seizure-free rates (≥ 5 years) following surgery for temporal lobe epilepsy are comparable to those reported in shorter-term studies.…”

Section: Discussionmentioning

confidence: 99%

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Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Griessenauer

Salam

Hendrix

et al. 2015

PED

129

112

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OBJECT Evidence in support of hemispherectomy stems from a multitude of retrospective studies illustrating individual institutions' experience. A systematic review of this topic, however, is lacking in the literature. METHODS A systematic review of hemispherectomy for the treatment of refractory epilepsy available up to October 2013 was performed using the following inclusion criteria: reports of a total of 10 or more patients in the pediatric age group (≤ 20 years) undergoing hemispherectomy, seizure outcome reported after a minimum follow-up of 1 year after the initial procedure, and description of the type of hemispherectomy. Only the most recent paper from institutions that published multiple papers with overlapping study periods was included. Two reviewers independently applied the inclusion criteria and extracted all the data. RESULTS Twenty-nine studies with a total of 1161 patients met the inclusion criteria. Seizure outcome was available for 1102 patients, and the overall rate of seizure freedom at the last follow-up was 73.4%. Sixteen studies (55.2%) exclusively reported seizure outcomes of a single type of hemispherectomy. There was no statistically significant difference in seizure outcome and type of hemispherectomy (p = 0.737). Underlying etiology was reported for 85.4% of patients with documented seizure outcome, and the overall distribution of acquired, developmental, and progressive etiologies was 30.5%, 40.7%, and 28.8%, respectively. Acquired and progressive etiologies were associated with significantly higher seizure-free rates than developmental etiologies (p < 0.001). Twenty of the 29 studies (69%) reported complications. The overall rate of hydrocephalus requiring CSF diversion was 14%. Mortality within 30 days was 2.2% and was not statistically different between types of hemispherectomy (p = 0.787). CONCLUSIONS Hemispherectomy is highly effective for treating refractory epilepsy in the pediatric age group, particularly for acquired and progressive etiologies. While the type of hemispherectomy does not have any influence on seizure outcome, hemispherotomy procedures are associated with a more favorable complication profile.

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Section: 2741supporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Griessenauer

Salam

Hendrix

et al. 2015

PED

129

112

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“…Again, Rasmussen and Sturge-Weber syndromes and vascular insults had a better prognosis (94.6% of patients became seizure free) than did multilobar cerebral dysplasia and other etiologies (68% seizure free). 9,10,18,21,22,34,36,55,60,65 When comparing different techniques, the seizure outcome seems to be constant. Another case series comparing anatomical hemispherectomy, functional hemispherectomy, and hemispherotomy 12 showed no significant differences between the 3 groups, with 71% of patients overall…”

Section: Surgical Outcomementioning

confidence: 99%

Hemispherotomy and other disconnective techniques

Ribaupierre

Delalande

2008

FOC

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The surgical treatment of intractable epilepsy has evolved as new technical innovations have been made. Hemispherotomy techniques have been developed to replace hemispherectomy in order to reduce the complication rates while maintaining good seizure control. Disconnective procedures are based on the interruption of the epileptic network rather than the removal of the epileptogenic zone. They can be applied to hemispheric pathologies, leading to hemispherotomy, but they can also be applied to posterior quadrant epilepsies, or hypothalamic hamartomas. In this paper, the authors review the literature, present an overview of the historical background, and discuss the different techniques along with their outcomes and complications.

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“…In particular, neural plasticity in early development allows recovery of motor performance even after hemispherectomy (7). Animal studies also show few deficits in motor function after neonatal cortical injury (8,9).…”

mentioning

confidence: 99%

Increased GABA-A Receptor Binding and Reduced Connectivity at the Motor Cortex in Children with Hemiplegic Cerebral Palsy: A Multimodal Investigation Using ¹⁸F-Fluoroflumazenil PET, Immunohistochemistry, and MR Imaging

Kim

Park

et al. 2013

J Nucl Med

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Hemispherectomy for intractable unihemispheric epilepsy Etiology vs outcome

Abstract: Hemidecortication continues to be a beneficial procedure in reducing seizure frequency in cases of unilateral cortical epilepsy. Fewer children with migrational disorders are seizure-free.

Cited by 202 publications

References 13 publications

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Hemispherotomy and other disconnective techniques

Increased GABA-A Receptor Binding and Reduced Connectivity at the Motor Cortex in Children with Hemiplegic Cerebral Palsy: A Multimodal Investigation Using ¹⁸F-Fluoroflumazenil PET, Immunohistochemistry, and MR Imaging

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Hemispherectomy for intractable unihemispheric epilepsy Etiology vs outcome

Abstract: Hemidecortication continues to be a beneficial procedure in reducing seizure frequency in cases of unilateral cortical epilepsy. Fewer children with migrational disorders are seizure-free.

Cited by 202 publications

References 13 publications

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Hemispherotomy and other disconnective techniques

Increased GABA-A Receptor Binding and Reduced Connectivity at the Motor Cortex in Children with Hemiplegic Cerebral Palsy: A Multimodal Investigation Using 18F-Fluoroflumazenil PET, Immunohistochemistry, and MR Imaging

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Increased GABA-A Receptor Binding and Reduced Connectivity at the Motor Cortex in Children with Hemiplegic Cerebral Palsy: A Multimodal Investigation Using ¹⁸F-Fluoroflumazenil PET, Immunohistochemistry, and MR Imaging