Abstract
Objectives: Hemispheric disconnection has been used as a treatment of medically refractory epilepsy and evolved from anatomic hemispherectomy to functional hemispherectomies to hemispherotomies. The hemispherotomy procedure involves disconnection of an entire hemisphere with limited tissue resection and is reserved for medically-refractory epilepsy due to diffuse hemispheric disease. Although it is thought to be effective by preventing seizures from spreading to the contralateral hemisphere, the electrophysiological effects of a hemispherotomy on the ipsilateral hemisphere remain poorly defined. The objective of this study was to evaluate the effects of hemispherotomy on the electrophysiologic dynamics in peri-stroke and dysplastic cortex.Methods: Intraoperative electrocorticography (ECoG) was recorded from ipsilateral cortex in 5 human subjects with refractory epilepsy before and after hemispherotomy. Power spectral density, mutual information, and phase-amplitude coupling were measured from the ECoG signals.Results: Epilepsy was a result of remote perinatal stroke in three of the subjects. In two of the subjects, seizures were a consequence of dysplastic tissue: one with hemimegalencephaly and the second with Rasmussen's encephalitis. Hemispherotomy reduced broad-band power spectral density in peri-stroke cortex. Meanwhile, hemispherotomy increased power in the low and high frequency bands for dysplastic cortex. Functional connectivity was increased in lower frequency bands in peri-stroke tissue but not affected in dysplastic tissue after hemispherotomy. Finally, hemispherotomy reduced band-specific phase-amplitude coupling in peristroke cortex but not dysplastic cortex.Significance: Disconnecting deep subcortical connections to peri-stroke cortex via a hemispherotomy attenuates power of oscillations and impairs the transfer of information from large-scale distributed brain networks to the local cortex. Hence, hemispherotomy reduces heterogeneity between neighboring cortex while impairing phase-amplitude coupling. In contrast, dysfunctional networks in dysplastic cortex lack the normal connectivity with distant networks. Therefore hemispherotomy does not produce the same effects.
Highlights
Since its first description in 1938, hemispheric disconnection has been used as a treatment of medically refractory epilepsy (McKenzie, 1938)
Post-hoc analysis showed that prior to hemispherotomy, power spectral density estimate (PSD) of group 1 was significantly greater than the PSD of group 2 across the frequency spectra (p < 0.05)
While it can be associated with significant morbidities (e.g., Hemiparesis, visual/sensory deficits, and speech/cognitive deficits), the procedure may reduce the frequency or entirely eliminate clinical seizures in children suffering from life-debilitating epilepsy and enable a more normal development
Summary
Since its first description in 1938, hemispheric disconnection has been used as a treatment of medically refractory epilepsy (McKenzie, 1938) This procedure has evolved from functional hemispherectomies (Rasmussen, 1983; Villemure and Rasmussen, 1993; Villemure et al, 2003) to functional hemispherotomies (Schramm et al, 1995; Villemure and Mascott, 1995; Carson et al, 1996; Kestle et al, 2000; Daniel et al, 2001; Limbrick et al, 2009). A hemispherotomy prevents seizures from propagating and producing clinical symptoms and mitigates (but not eliminates) some complications associated with traditional hemispherectomies such as hydrocephalus (Villemure and Mascott, 1995; Limbrick et al, 2009)
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