Barbara Schmeiser1, Josef Zentner2, Bernhard Jochen Steinhoff3, Andreas Schulze-Bonhage4, Evangelos Kogias2, Anne-Sophie Wendling3, Thilo Hammen4. 1. Department of Neurosurgery, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany. Electronic address: barbara.schmeiser@uniklinik-freiburg.de. 2. Department of Neurosurgery, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany. 3. Epilepsy Center Kork, Landstrasse 1, 77694 Kehl, Germany. 4. Epilepsy Center, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany.
Abstract
INTRODUCTION: Functional hemispherectomy (FH) is a well-established therapeutic option for children with epilepsy with parenchymal damage confined to one hemisphere, yet its application in adults remains rare. The intention of our study was to investigate postoperative clinical and epileptological outcome in adults who received FH for intractable epilepsy. MATERIALS AND METHODS: We retrospectively analyzed 12 adult patients (18-56years) with intractable epilepsy due to unihemispheric pathology. All patients underwent FH. Postoperative neurological and cognitive outcome as well as seizure status were evaluated with a mean follow-up period of 4.9years. RESULTS: Ten patients (83%) were seizure-free (Engel I), and two (17%) had recurrent seizures at last follow-up. Apart from one patient requiring operative revision for bone flap infection, no perioperative morbidity or mortality occurred. Postoperative functional assessment revealed deterioration of motor function in 7 patients, whereas 5 remained unchanged. Language was unchanged in 8 patients. The absence of background slowing in preoperative electroencephalogram (EEG) as well as ictal and interictal EEG patterns located ipsilateral to the side of surgery was associated with favorable seizure outcome. CONCLUSION: Favorable seizure control and acceptable functional outcome can be achieved by FH in adults with intractable epilepsy. The risk of postoperative deficits is moderate and even older patients are able to manage postoperative motor impairment. Therefore, FH should be considered in case of unihemispheric lesions also in adults.
INTRODUCTION: Functional hemispherectomy (FH) is a well-established therapeutic option for children with epilepsy with parenchymal damage confined to one hemisphere, yet its application in adults remains rare. The intention of our study was to investigate postoperative clinical and epileptological outcome in adults who received FH for intractable epilepsy. MATERIALS AND METHODS: We retrospectively analyzed 12 adult patients (18-56years) with intractable epilepsy due to unihemispheric pathology. All patients underwent FH. Postoperative neurological and cognitive outcome as well as seizure status were evaluated with a mean follow-up period of 4.9years. RESULTS: Ten patients (83%) were seizure-free (Engel I), and two (17%) had recurrent seizures at last follow-up. Apart from one patient requiring operative revision for bone flap infection, no perioperative morbidity or mortality occurred. Postoperative functional assessment revealed deterioration of motor function in 7 patients, whereas 5 remained unchanged. Language was unchanged in 8 patients. The absence of background slowing in preoperative electroencephalogram (EEG) as well as ictal and interictal EEG patterns located ipsilateral to the side of surgery was associated with favorable seizure outcome. CONCLUSION: Favorable seizure control and acceptable functional outcome can be achieved by FH in adults with intractable epilepsy. The risk of postoperative deficits is moderate and even older patients are able to manage postoperative motor impairment. Therefore, FH should be considered in case of unihemispheric lesions also in adults.
Authors: Robert A McGovern; Ahsan N V Moosa; Lara Jehi; Robyn Busch; Lisa Ferguson; Ajay Gupta; Jorge Gonzalez-Martinez; Elaine Wyllie; Imad Najm; William E Bingaman Journal: Epilepsia Date: 2019-11-02 Impact factor: 5.864
Authors: C Ákos Szabó; Rachel Garvin; Shaheryar Hafeez; Ali Seifi; Linda Leary; Ratna Bhavaraju-Sanka; James M Henry; Alex M Papanastassiou Journal: Epilepsy Behav Case Rep Date: 2018-11-28