Seizure outcomes after hemispherectomy for drug resistant epilepsy in childhood and adolescence

Abstract

Objective and purposeHemispherectomy produces remarkable results in terms of seizure outcomes and quality of life for drug resistant hemispheric epilepsy. We reviewed the neurophysiology, neuroradiologic findings, pathologic findings, epilepsy characteristics, and clinical long-term outcomes in childhood and adolescence patients following a hemispherectomy. This study explores the post hemispherectomy seizure outcomes. MethodsWe retrospectively reviewed the records of 64 patients after a hemispherectomy at King faisal Specialist Hospital and Research Center between 2000 and 2014. Clinical, EEG, imaging, and surgical data were collected. Seizure outcome evaluated during follow-up in 1, 3, and 5 years.This study was approved by the ethics committee in King Faisal Specialty Hospital and Research Center (RAC# 2161 142).Patient consent to review their medical records was not required by the institutional Office of Research Affairs of the King Faisal Specialty Hospital and Research Center because this is a retrospective study. Patient confidentiality was ensured because patient identity not reported and no single information about patient names or info. ResultsOur cohort consisted of 26 male and 38 female children and adolescents. The majority of seizure onset during neonatal period, and the youngest age at surgery was 4 months old. Seizure frequency recorded at home as daily in 36 patients (56.25%), with significant impacts on their life.Focal cortical dysplasia (FCD) confirmed in a total of 17 cases (26.56%), leptomeningeal angiomatosis (sturge-weber syndrome) 2cases (3.13%), Heterotopia in 10 cases (15.63%), Gliosis in 13 cases (20.31%), Sclerosis 4 cases (6.25%), Chronic inflammation 6 cases (9.38%), Encephalomalacia 8 cases (12.5%) Brain tumors 3 cases (4.68%). Single cases of sole Cavernous angioma were diagnosed.In our study, most of the children and adolescents achieved seizure freedom. At follow up of 1–5 years, after first year follow up 39 patients (67.24%) achieved seizure freedom (ILAE I), and Three years follow-up after hemispherectomy, revealed 23 patients (59%) achieved seizure freedom (ILAE I) While five years follow up of hemispherectomy patients showed (ILAE I) in 7 patients (44%). ConclusionsThis study shows good long-term seizure outcomes after hemispherectomy. Seizure freedom has been achieved in the majority of the patients after 3 and 5 years.