Functional Outcomes of Hemispherectomy in Early Versus Late Pathophysiology
Prolonged, uncontrolled epilepsy, at times resulting in hundreds of seizures per day, severely affects one’s quality of life. While cerebral hemispherectomy (CHE) is a radical procedure, it has become a viable treatment option for children with medically intractable seizures. Research on functional outcomes following CHE, however, has been lacking. In the current study, functional outcomes were assessed across language, motor, vocational, social, and behavioral domains. A novel approach utilizing an estimated age at brain injury, as identified by the pediatric neurosurgeon, was utilized to help provide better predictive value than the phenotypical presentation of seizures or factors such as age at seizure onset, seizure etiology, and underlying brain pathology. Additionally, a novel functional outcome score that consists of five domains: seizure control, antiepileptic drug use, language skills, attention, academic skills, and motor skills, was utilized to assess outcome following CHE. Findings indicated that those with earlier estimated age at brain injury had better seizure control than those with later estimated age at brain injury. There was an estimated age at brain injury and side of CHE effect, as those with earlier estimated age at brain injury and left CHE had more stable seizure control, less antiepileptic drug (AED) use after surgery, and better attentional control. However, more behavior problems were noted in this younger group. The predictive value of the estimated age at brain injury and outcome as measured by the functional outcome score is discussed.
Marion, Sarah DeBoard
Epilepsy in children, Brain-damaged children, Pediatric neuropsychology, Cerebral hemispheres
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