Etiology Influences Prognosis in Hemispherectomy Patients
Abstract number :
2.321
Submission category :
Year :
2001
Submission ID :
2975
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
J.Y. Wu, MD, Pediatric Neurology, UCLA, Los Angeles, CA; S. Koh, MD, Pediatric Neurology, UCLA, Los Angeles, CA; G.W. Mathern, MD, Neurosurgery, UCLA, Los Angeles, CA; R. Asarnow, PhD, Psychiatry, UCLA, Los Angeles, CA; W.D. Shields, MD, Pediatric Neurolo
RATIONALE: Hemispherectomy significantly reduces seizure frequency in children with medically intractable seizures. We hypothesized that the outcome of hemispherectomy for intractable seizures may be influenced by the etiology of the refractory epilepsy.
METHODS: We reviewed the records of 52 children with intractable seizures who underwent functional or anatomical hemispherectomy at the University of California, Los Angeles (UCLA) between 1986 and 2000. They were subgrouped by etiology into Rasmussen[ssquote]s encephalitis (n=15) , prenatal infarction (n=23), and hemimegalencephaly (n=14). A subset of these 52 children was administered the Vineland Adaptive Behavior Scales prior to surgery to determine their level of adaptive functioning (Rasmussen[ssquote]s=8, infarction=16, hemimegalencephaly=11).
RESULTS: The percentage of children achieving seizure freedom 2 years after hemispherectomy in those with an acquired etiology (Rasmussen[ssquote]s or infarction) was 50%. This significantly differs from the 21% seizure-free rate in the hemimegalencephaly subgroup (p=0.026). In addition, those with an acquired etiology were more likely than the hemimegalencephaly group to be off all anticonvulsants at their 2 year follow-up, 26% vs 7% (p=0.033). Lastly, in those children with an acquired etiology, we found an inverse relationship between duration of seizures before surgery and their preoperative developmental quotient (linear regression with r=0.58, slope=-2.08, p=0.003), such that the shorter the seizure duration before surgery the better their developmental level. Such a relationship was not seen in the hemimegalencephaly subgroup (r=0.53, p=0.095).
CONCLUSIONS: Prognosis in hemispherectomy patients depends on their seizure etiology. Compared with the hemimegalencephalic children, those with an acquired etiology (Rasmussen[ssquote]s or infarction) are more likely at 2 years postoperatively to be seizure-free and to be off all anticonvulsants. In addition, prompt surgery for these patients is associated with better development, an effect not discernible in the hemimegalencephaly subgroup.