The Dilemma of Hemispherectomy for Rasmussen's Encephalitis in a Neurologically Intact Child

Abstract

Rasmussen's encephalitis is a rare drug-resistant focal epilepsy characterized by progressive hemiparesis, hemianopia, and cognitive decline. Hemispherectomy is currently the only known treatment that can be curative, though expected to cause postoperative motor and visual deficits in children and adolescents. To date, medical treatment with antiseizure medications and immunosuppressive agents can only offer partial, delayed, or temporary alleviation of symptoms. Hence, patients and families are often faced with the difficult decision to consider the possibility of seizure freedom at the cost of incurring permanent deficits. Here, we discussed the unique ethical issues when faced with a cure that can cause harm, and also discussed a shared decision-making approach guided by informed consent, principles of autonomy, and patient-centered values.

Long‐term seizure outcome and mobility after surgical treatment for Rasmussen encephalitis in children: A single‐center experience

“…Hemispheric surgery for the treatment of refractory epilepsy is still considered a radical intervention, although, in recent years, there has been a gradually increasing number of publications confirming its efficacy and reduced morbidity and mortality 25,29 ; this was also proven by our case series, which had a low complication rate. Our findings also hold up the notion that more extensive resections are not necessary, which implies lower surgical risks and corroborates the work of Kim et al, who, despite emphasizing that the surgical technique must be individualized for each patient, showed that disconnective techniques present similar clinical results and lower morbidity as compared to larger hemispheric resections.…”