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Predicting seizure outcomes and functional outcomes after hemispherotomy: are we any better?

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Abstract

Introduction

Present study attempted to analyze seizure freedom and detailed functional outcomes after functional hemispherotomy and utility of hemispherotomy outcome prediction scale (HOPS) scores in predicting outcomes.

Methods

Patients who underwent functional hemispherotomy were analyzed for clinical presentation, neuroimaging, seizure outcomes, and functional outcomes.

Results

A total of 76 procedures were performed on 69 patients. Mean age at the surgery was 8 ± 6.1 years. Fourteen patients were < 2 years. Age of onset epilepsy of the cohort was 2.0 ± 3.3 years. All had severe catastrophic epilepsy with multiple daily seizures. All patients had motor deficits with 36 (52%) patients had contralateral dysfunctional hand. Perinatal stroke (49%) was most common substrate followed by cortical malformations (21.7%). Eight patients had contralateral imaging abnormalities. Fifty-nine (86.76%) patients remained seizure free (Engle 1a) at 41 + -20.9 months. HOPS scores were available for 53 patients and lowest seizure outcome was 71% for HOPS score of 4. Lower HOPS scores predicted better seizure outcomes. Cortical malformations operated earlier than 2 years predicted poor seizure outcomes (66.6%). Positive functional outcomes are recorded in 80% of patients with 78% reporting improvement from the pre-surgical level. Five (7.2%) patients underwent shunt surgery. One mortality recorded.

Conclusions

Hemispherotomy has excellent seizure outcomes. Early surgery in cortical malformations appears to be predictor of poorer seizure outcomes. HOPS score is a good tool to predict the seizure outcomes. Hemispherotomy is perceived to improve the Cognitive and functional performance.

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Authors and Affiliations

  1. Bajaj Alliance Centre for Epilepsy, Deenanath Mangeshkar Hospital, Room No 705, A wing, 7th Floor, Old Building, Erandwane, Pune, India, 411004

    Nilesh S. Kurwale, Deepa Bapat, Sujit A. Jagtap, Sandeep B. Patil, Aniruddha Joshi, Sujit Nilegaonkar, Sonal Chitnis, Zubin Shah & Prasanthi Aripirala

  2. Neoclinic Children’s Hospital, Jaipur, India

    Vivek Jain

  3. Department of Department of Radiology, Star Imaging Institute, Pune, India

    Yogeshwari Deshmukh

Authors
  1. Nilesh S. Kurwale
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  2. Deepa Bapat
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  3. Sujit A. Jagtap
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  4. Sandeep B. Patil
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  5. Vivek Jain
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  6. Aniruddha Joshi
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  7. Yogeshwari Deshmukh
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  8. Sujit Nilegaonkar
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  9. Sonal Chitnis
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  10. Zubin Shah
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  11. Prasanthi Aripirala
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Contributions

Data collection was done by Nilesh S. Kurwale, Deepa Bapat, Prasanthi Aripirala, and Zubin Shah. Compilation of the data and interpretation was done by Nilesh Kurwale, Deepa Bapat, Sujit Jagtap, and Sandeep Patil. Manuscript writing was done by Nilesh S. Kurwale, Deepa Bapat, and Vivek Jain. Critical editing and review of the manuscript was done by all the authors in their respective parts.

Corresponding author

Correspondence to Nilesh S. Kurwale.

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Kurwale, N.S., Bapat, D., Jagtap, S.A. et al. Predicting seizure outcomes and functional outcomes after hemispherotomy: are we any better?. Childs Nerv Syst 40, 503–509 (2024). https://doi.org/10.1007/s00381-023-06151-4

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  • DOI: https://doi.org/10.1007/s00381-023-06151-4

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