Long-term Functional Outcome and Predictors After Hemispherectomy in Children

In the August 23rd early access of the journal Epilepsia, Drs. Moosa and colleagues from the Departments of Neurology and Neurosurgery and the Pediatric Epilepsy Center at the Neurological Institute at Cleveland Clinic present results of one of the largest studies of 186 children who have undergone hemispherectomy for epilepsy between 1997 to 2009.

• 56% were seizure free and 36% had seizure recurrence.

  • Ten patients or 8% were free of their preoperative seizures, but had new-onset non-epileptic events and were ultimately excluded from further analysis.

  • At follow up, 83% of patients were able to walk independently; 8.7% walked with assistance; and 9 or 7.8% were unable to walk.

  • 24% reported new visual symptoms that were not present preoperatively.

  • 70% had satisfactory spoken language skills; 42% of kids older than six years had satisfactory reading skills.

  • 27% reported behavioral problem; 6.2% of the kids aged between 6 and 18 years attended mainstream school without assistance.

  • Forty-eight kids or 59% were in mainstream school with assistance and the rest were in a special school for the disabled or in home care. 21% of the patients older than 18 years were gainfully employed.

Statistical analysis identified the following factors as associated with a poor outcome from hemispherectomy:

1. Seizure recurrence negatively affected all functional domains.

2. Abnormalities in the unoperated hemisphere on magnetic resonance imaging and pre-existing quadriparesis correlated with poor motor outcomes.

3. Multi-lobe or MRI abnormalities on the contralateral hemisphere and young age at hemispherectomy correlated with poor language outcome, and younger age at epilepsy onset correlated with poor reading skills but not with spoken language skills.