Hemispherectomy: A Viable Surgical Treatment for Adults with Intractable Epilepsy - A Report of 5 Cases (P01.069)

Abstract

Objective: To evaluate the outcome after hemispherectomy in adult patients with refractory epilepsy, and increase awareness of hemispherectomy as a viable surgical option in this population. Background Hemispherectomy is a surgical technique that is often used in refractory epilepsies, and is well-known to be successful in the treatment of unilateral hemispheric lesions. Most case series, however, are in the pediatric population. Despite some reports of success in the adult population, this procedure is still underutilized, presumably because of concerns of significant postoperative neurological deficits due to lack of plasticity in the adult brain. Design/Methods: A retrospective chart review identified 5 patients. In four, seizures were due to perinatal stroke, and 1 had a presumed viral syndrome (not Rasmussen encephalitis). All patients had varying degrees of hemiparesis and visual field abnormalities, but were ambulatory at baseline. Four had functional hemispherectomy, and 1 had an anatomic hemispherectomy following a functional hemispherectomy. Three patients had right and 2 patients had left hemispheric lesions. Preoperative EEG, MRI, and neuropsychological testing were completed in all patients. Two patients had a pre-surgical PET scan, and one had functional MRI prior to surgery. Results: Postoperatively, 3 of the 5 patients are seizure free, with an average follow up of 15 months (range 3-34 months). One patient had a significant improvement in seizures (Engel class II) sustained at 1.5 years, and 1 patient had greater than 70% reduction, with resolution of disabling seizures (Engel I). Only one patient had post-operative complications, consisting of severe headaches. One patient complained of mild occasional orthostasis at 3 months post-operatively. None of the patients experienced any worsening in neurological status, and 2 patients reported improvement in motor and/or communicative function. Conclusions: Hemispherectomy can be a valuable surgical option without significant postoperative deficits in adult patients with hemispheric lesions causing intractable seizures. Disclosure: Dr. Schusse has nothing to disclose. Dr. Schusse has nothing to disclose. Dr. Drees has nothing to disclose.