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Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients
Author(s) -
McGovern Robert A.,
N. V. Moosa Ahsan,
Jehi Lara,
Busch Robyn,
Ferguson Lisa,
Gupta Ajay,
GonzalezMartinez Jorge,
Wyllie Elaine,
Najm Imad,
Bingaman William E.
Publication year - 2019
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16378
Subject(s) - hemispherectomy , cerebral peduncle , ictal , epilepsy , neuropsychology , ambulatory , epilepsy surgery , medicine , psychology , magnetic resonance imaging , electroencephalography , longitudinal study , surgery , pediatrics , psychiatry , cognition , white matter , radiology , internal capsule , pathology
Abstract Objective To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents. Methods We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed. Results Thirty‐six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow‐up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6‐month follow‐up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes. Significance Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.