Seizure Outcome and Its Prognostic Predictors After Hemispherotomy in Children With Refractory Epilepsy in a Chinese Pediatric Epileptic Center

Abstract

Object: To explore the post-hemispherotomy seizure outcome and its prognostic predictors in children with refractory epilepsy. Methods: We reviewed 83 consecutive child patients with refractory epilepsy who underwent a hemispherectomy from June 2014 to January 2017 at our Pediatric Epilepsy Center. Demographic, clinical, EEG, neuroimaging, and surgical data were collected. Seizure outcome data were collected via outpatient clinics as well as telephone visits and were graded according to Engel criteria. Logistic regression model and Cox proportional hazard regression model were, respectively, applied to explore the related factors predicting the seizure outcomes of children after a hemispherotomy. Results: Of the 83 patients, 55 (63.2%) were male. The mean seizure onset age was 1.9 years (0–8.7 years), and the mean surgery age was 5 years (0.8–14 years). At a mean follow-up of 3 years, 69 children (83.1%) were seizure free, and 14 (16.9%) exhibited seizure recurrence. In a univariate analysis, whether or not considering follow-up time, a non-lateralized interictal EEG pattern, bilateral PET abnormalities and acute postoperative seizures (APOS) could all predict poor seizure outcomes post-hemispherotomy. Bilateral PET abnormalities were independently correlated with unfavorable seizure outcomes in the multivariate Logistic regression analysis (Odds ratio( OR ) = 13.05, 95% CI = 1.52–112.29 , P = 0.019) and in the multivariate Cox proportional hazard analysis( OR = 13.99, 95% CI = 2.75–71.17, P = 0.001). Conclusions: Child epileptic patients with bilateral PET abnormalities may have poor seizure outcomes after a hemispherotomy procedure. This study will facilitate better candidate selection for hemispherotomies and early identification of unfavorable seizure outcomes.

Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis

“…After exclusion of 111 studies (42 did not meet the inclusion criteria, 35 included overlapping populations, and 34 had insufficient data), a total of 25 studies met the inclusion criteria and were included in our study. 6,8,11,16,17,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] All 25 studies were retrospective consecutive case series and published between 2000 and 2019, with the cumulative studied period ranging from 1990 to 2017. Sev-enteen studies reported on LPH, 7 reported on VPH, and 1 included both techniques (Table 1).…”

Application of combined multimodal neuroimaging and video-electroencephalography in intractable epilepsy patients for improved post-surgical outcome prediction

“…The epilepsy type and v-EEG also appeared to have varying degrees of predictive value for surgical outcomes in the present study, as in some previous studies. 19 Sex, age at first seizure, age at surgery, and seizure duration had no additional predictive value.…”

“…Surgery should be determined by comprehensive symptomatology, v-EEG, and PET/CT findings. 19 Multiple studies have shown that patients with unilateral focal PET abnormality might have better post-surgical seizure outcomes, while non-specific or bilateral FDG hypometabolism tends to predict poor seizure outcomes. 19,20 The present data showed similar findings.…”

“…19 Multiple studies have shown that patients with unilateral focal PET abnormality might have better post-surgical seizure outcomes, while non-specific or bilateral FDG hypometabolism tends to predict poor seizure outcomes. 19,20 The present data showed similar findings. Despite its high sensitivity to detecting hypometabolic zones, traditional PET/CT has a low spatial resolution.…”

Peri-Insular Hemispherotomy: A Systematic Review and Institutional Experience

“…In their series, 30/84 (35.7%) children had dysplastic pathology, a similar portion to the current systematic review (40.8%). Interestingly, one large class 3 study of 84 patients undergoing PIH did not observe any significant difference in Engel outcome between developmental and acquired pathology groups (86.9%, 83.3%, respectively) [28]. These insights suggest surgeon preference and experience may be more important than technique differences for patients with developmental pathology.…”