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Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients

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Abstract

Background

Hemispheric brain lesions are commonly associated with early onset of catastrophic epilepsies and multiple seizure types. Hemispheric surgery is indicated for patients with unilateral intractable epilepsy. Although described more than 50 years ago, several new techniques for hemispherectomy have only recently been proposed aiming to reduce operatory risks and morbidity.

Materials and methods

We present the clinical characteristics, presurgical workup, and postoperative outcome of a series of pediatric patients who underwent hemispherectomy for medically intractable epileptic seizures. Thirty-nine patients with medically intractable epilepsy underwent surgery from 1996 to 2005.

Results and discussion

We analyzed demographic data, interictal and ictal EEG findings, age at surgery, surgical technique and complications, and postsurgical seizure outcome. There were 74.4% males. Tonic and focal motor seizures occurred in 30.8 and 20.5% of the patients. Most frequent etiologies were Rasmussen encephalitis (30.8%) and malformation of cortical development (23.1%). Postsurgical outcomes were Engel classes I and II for 61.5% of the patients. In general, 89.5% of the patients exhibited at least a 90% reduction in seizure frequency. All patients had acute worsening of hemiparesis after surgery. Basically, two surgical techniques have been employed, both with similar results, although a trend has been noted toward one of the procedures which produced consistently complete disconnection. Patients with hemispheric brain lesions usually have abnormal neurological development and intractable epilepsy. When video-EEG monitoring and magnetic resonance imaging show unilateral disease, the patient may evolve with a good surgical outcome. We showed that a marked reduction in seizure frequency may be achieved, with acceptable neurological impairments.

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Acknowledgements

The authors thank the epilepsy fellows, neurology residents, and staff of the Epilepsy Outpatient Clinics and Video-EEG Monitoring Unit of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto/USP. This work was supported by FAPESP, CNPq, and FAEPA.

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Authors and Affiliations

  1. Department of Neurology, Psychiatry and Psychology,Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    Vera Cristina Terra-Bustamante, Luciana Midori Inuzuka, Regina Maria França Fernandes, Sara Escorsi-Rosset, Lauro Wichert-Ana, Veriano Alexandre Jr., Marino M. Bianchin & Américo Ceiki Sakamoto

  2. Department of Neurosurgery, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    Ricardo Oliveira dos Santos & Helio Rubens Machado

  3. Department of Radiology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    David Araújo & Antônio Carlos Santos

  4. Departmento de Neurologia, Centro de Cirurgia de Epilepsia-CIREP, Campus Universitário, Ribeirão Preto-SP, CEP 14048-900, Brazil

    Helio Rubens Machado

Authors
  1. Vera Cristina Terra-Bustamante
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  2. Luciana Midori Inuzuka
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  3. Regina Maria França Fernandes
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  4. Sara Escorsi-Rosset
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  5. Lauro Wichert-Ana
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  6. Veriano Alexandre Jr.
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  7. Marino M. Bianchin
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  8. David Araújo
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  9. Antônio Carlos Santos
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  10. Ricardo Oliveira dos Santos
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  11. Helio Rubens Machado
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  12. Américo Ceiki Sakamoto
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Corresponding author

Correspondence to Helio Rubens Machado.

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Terra-Bustamante, V.C., Inuzuka, L.M., Fernandes, R.M.F. et al. Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients. Childs Nerv Syst 23, 321–326 (2007). https://doi.org/10.1007/s00381-006-0212-6

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  • DOI: https://doi.org/10.1007/s00381-006-0212-6

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