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Five or More Acute Postoperative Seizures Predict Hospital Course and Long‐term Seizure Control after Hemispherectomy
Author(s) -
Koh Susan,
Nguyen Snow,
Asarnow Robert F.,
LoPresti Christine,
Yudovin Sue,
Shields W. Donald,
Vinters Harry V.,
Mathern Gary W.
Publication year - 2004
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/j.0013-9580.2004.50203.x
Subject(s) - hemispherectomy , medicine , epilepsy , epilepsy surgery , anesthesia , pediatrics , surgery , psychiatry
Summary:  Purpose : Acute postoperative seizures (APOSs) are those that occur in the first 7 to 10 days after surgery, and previous studies in temporal lobe epilepsy patients support the notion that APOSs may foretell failure of long‐term seizure control. It is unknown whether APOSs also predict seizure outcome or hospital course after hemispherectomy. Methods: Hemispherectomy patients (n = 114) were studied retrospectively and subdivided into the following groups: No APOSs, 1 to 5 APOSs, or >5 APOSs. Intensive care unit (ICU) nursing staff or family members reported and described the APOS events. APOS categories were compared with pre‐ and postsurgery clinical variables abstracted from the medical record. Results : APOSs occurred in 22.6% of hemispherectomy patients. Compared with the 0 and 1 to 5 APOS groups, patients with >5 APOS showed (a) longer seizure durations before surgery, (b) longer hospitalizations, (c) later oral food intake, (d) more frequent lumbar punctures, (e) worse seizure control at 0.5 and 1 year after surgery, (f) more antiepileptic drug (AED) use at 2 and 5 years after surgery, and (g) higher reoperation rate. No similar differences were found between the 0 and 1 to 5 APOS groups. The day of the APOS, whether the APOS was typical of preoperative seizures, and postsurgery scalp EEG did not predict long‐term seizure control. APOS patients in the 1 to 5 and >5 groups had lower pre‐ and postsurgery Vineland developmental quotients compared with those without an APOS. Conclusions: Hemispherectomy patients with >5 APOSs had a more prolonged and complicated hospital course and worse postsurgery seizure control, more AED use, and higher reoperation rate than did patients with 0 or 1 to 5 APOSs. Thus the number of APOSs was a predictor of postsurgery seizure control and can be used to counsel patients and families about prognosis after hemispherectomy.

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