Seizure outcome, functional outcome, and quality of life after hemispherectomy in adults
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Functional hemispherectomy is a well-established method in childhood epilepsy surgery with only a few reports on its application in adults.
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).
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 %).
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.
KeywordsHemispherectomy Epilepsy surgery Adult Seizure outcome Functional outcome
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