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EEG lateralization and seizure outcome following peri-insular hemispherotomy for pediatric hemispheric epilepsy

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Abstract

Objective

To determine whether preoperative non-lateralizing scalp electroencephalography (EEG) influences seizure outcome following peri-insular hemispherotomy (PIH) in pediatric hemispheric epilepsy.

Methods

Retrospective data was collected on all 45 pediatric patients who underwent PIH between 2005 and 2016. All underwent a basic pre-surgical evaluation consisting of detailed history and examination, neuropsychological assessment, MRI, and EEG. SPECT/PET, fRMI, or Wada testing were done in only eight patients. Seizure outcome was assessed using the Engel classification.

Results

Among those who underwent hemispherotomy, 20 (44%) were females. Mean age at surgery was 8 ± 4.3 years and mean duration of symptoms was 5.2 ± 3.7 years. The most common etiologies of hemispheric epilepsy were hemiconvulsion-hemiplegia epilepsy syndrome, Rasmussen encephalitis, and post-encephalitic sequelae, together comprising 27 (60%) patients. Among the 44 patients with follow-up data (mean duration 48 ± 33 months), seizure freedom (Engel class I) was attained by 41 (93.2%). Anti-epileptic medications were stopped or decreased in 36 (82%). Seventeen (38.6%) patients had non-lateralizing EEG. Seizure outcome was not related to lateralization of EEG activity.

Conclusions

PIH provides excellent long-term seizure control in patients despite the presence of non-lateralizing epileptiform activity, although occurrence of acute postoperative seizures may be higher. Routine SPECT/PET may not be required in patients with a non-lateralizing EEG if there is good clinico-radiological concordance.

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Authors and Affiliations

  1. Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

    Ananth P. Abraham, Maya Mary Thomas, Vivek Mathew, Karthik Muthusamy, Sangeetha Yoganathan, G. Edmond Jonathan, Krishna Prabhu & Ari G. Chacko

  2. Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland

    Roy Thomas Daniel

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  1. Ananth P. Abraham
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  2. Maya Mary Thomas
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Correspondence to Maya Mary Thomas.

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The authors report no conflict of interest. The datasets generated for the study are available from the corresponding author on reasonable request.

Disclosure

A portion of this study was presented as a podium presentation at the 66th Annual Conference of the Neurological Society of India in December, 2017.

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Abraham, A.P., Thomas, M.M., Mathew, V. et al. EEG lateralization and seizure outcome following peri-insular hemispherotomy for pediatric hemispheric epilepsy. Childs Nerv Syst 35, 1189–1195 (2019). https://doi.org/10.1007/s00381-019-04067-6

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  • DOI: https://doi.org/10.1007/s00381-019-04067-6

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