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Developmental plasticity after right hemispherectomy in an epileptic adolescent with early brain injury

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Abstract

Objectives

The authors present the case of an adolescent affected with refractory epilepsy due to a neonatal ischemic infarction of the right medial cerebral artery. Hemiplegic since the first months of life, she began presenting motor partial seizures associated with drop attacks at 4.5 years; these were initially well controlled by antiepileptic drugs, but at 10 years seizures appeared again and became refractory. Thus, at 14 years and 10 months, she was submitted to a right hemispherectomy that made her rapidly seizure free. In the post-surgical follow-up lasting 5 years, neuropsychological serial assessments showed an impressive progressive improvement of cognitive skills, namely, visuospatial abilities. This case seems to challenge the widely spread feeling that functional catch-up in brain-injured children could only occur early in life. In effect, the astonishing recovery especially of visuospatial skills in our case occurred in adolescence after a late surgical intervention of right hemispherectomy.

Methods

Different neuropsychological aspects are discussed. The reorganisation process recovered the spatial and linguistic abilities as well as the verbal and visuospatial memory; however, there was a persistent impairment of complex spatial and perceptual skills as well as recall abilities. Despite the deficit of complex visual stimuli processing, the patient showed a good performance in the recognition of unknown faces.

Conclusions

Probably, the absence of seizures in the first 4 years of life could have allowed a generally adequate compensatory reorganisation, successively masked by the persistent and diffuse epileptic disorder. The seizure control produced by surgery eventually made evident the effectiveness of the brain reorganisation.

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Authors and Affiliations

  1. Department of Medical and Surgical Pediatrics and Developmental Neuroscience, Unit of Neuropsichiatria Infantile, Catholic University, Policlinico Gemelli, Largo Gemelli 8, 00168, Rome, Italy

    F. Chiricozzi, D. Chieffo, D. Battaglia, L. Iuvone, C. Acquafondata, L. Cesarini, A. Sacco, R. Chiera & F. Guzzetta

  2. Department of Medical and Surgical Pediatrics and Developmental Neuroscience, Unit of Neurochirurgia Infantile, Catholic University, Rome, Italy

    C. Di Rocco

Authors
  1. F. Chiricozzi
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  2. D. Chieffo
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  3. D. Battaglia
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  4. L. Iuvone
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  5. C. Acquafondata
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  6. L. Cesarini
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  7. A. Sacco
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  8. R. Chiera
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  9. C. Di Rocco
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  10. F. Guzzetta
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Correspondence to F. Guzzetta.

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Chiricozzi, F., Chieffo, D., Battaglia, D. et al. Developmental plasticity after right hemispherectomy in an epileptic adolescent with early brain injury. Childs Nerv Syst 21, 960–969 (2005). https://doi.org/10.1007/s00381-005-1148-y

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  • DOI: https://doi.org/10.1007/s00381-005-1148-y

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