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Acta Neurochirurgica

, Volume 154, Issue 9, pp 1603–1612 | Cite as

Seizure outcome, functional outcome, and quality of life after hemispherectomy in adults

  • J. SchrammEmail author
  • D. Delev
  • J. Wagner
  • C. E. Elger
  • M. von Lehe
Clinical Article

Abstract

Background

Functional hemispherectomy is a well-established method in childhood epilepsy surgery with only a few reports on its application in adults.

Methods

We report on 27 patients (median age 30 years, range 19-55) with a follow-up of more than 1 year (median 124 months, range 13-234). Etiology was developmental in two (one schizencephaly, one hemimegalencephaly), acquired in 21 (two hemiatrophy, 17 porencephaly, two postencephalitic), and progressive in four (Rasmussen’s encephalitis).

Results

At last available follow-up, 22 patients were seizure free (81 % ILAE class 1), one had auras (4 % ILAE class 2), one had no more than three seizures per year (4 % ILAE class 3). Thirty-seven percent were without antiepileptic drugs. Seventeen patients of 20 responding patients stated improved quality of life after surgery, one patient reported deterioration, and two patients reported no difference. Additionally, a self-rated postoperative functional status and changes compared to the pre-operative status was assessed. Six patients improved in gait, ten remained unchanged, and four deteriorated. Three patients improved in speech, none deteriorated. Hand function got worse five times, and in 15 cases remained unchanged. There was no mortality, one bone flap infection, and one subdural hematoma. Hydrocephalus was seen in three cases (12 %).

Conclusions

It is possible to achieve good seizure outcome results despite long-standing epilepsy across a variety of etiologies, comparable to epilepsy surgery in pediatric patients. Adult patients do not have to expect more problems with new deficits, appear to cope quite well, and mostly profit from surgery in several quality of life domains.

Keywords

Hemispherectomy Epilepsy surgery Adult Seizure outcome Functional outcome 

Notes

Acknowledgments

We thank Professor H. Urbach for his long-term neuroradiological expertise and Prof. F. Rosenow, Marburg, for allowing us to include two cases where his team performed presurgical evaluation. We also wish to acknowledge the contribution of those colleagues who maintained the epilepsy surgery database in the past in the Department of Neurosurgery: H. Clusmann MD, T. Kral MD, E. Behrens MD. P. Süßmann and B. Harzheim helped with patient follow-up. Patient follow-up was funded as part of the transregional collaborative research consortium SFB-TR3 “Mesial temporal lobe epilepsies” of the Deutsche Forschungsgemeinschaft (DFG).

Conflicts of interest

None.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • J. Schramm
    • 1
    Email author
  • D. Delev
    • 1
  • J. Wagner
    • 2
  • C. E. Elger
    • 2
  • M. von Lehe
    • 1
  1. 1.Department of Neurosurgery, Bonn University Medical CenterUniversity of BonnBonnGermany
  2. 2.Department of Epileptology, Bonn University Medical CenterUniversity of BonnBonnGermany

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