FUNCTIONAL HEMISPHERECTOMY IN CATASTROPHIC EPILEPSIES: ROLE OF ETIOLOGY AND EEG ON PROGNOSIS FOR SEIZURE CONTROL
Abstract number :
3.209
Submission category :
Year :
2002
Submission ID :
3249
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Jaderson Costa da Costa, Andre Palmini, Eliseu Paglioli-Neto, Fabiane Mugnol, Victor Martinez, Ney Azambuja, Mirna Portuguez, Gilberto Trentin, Eduardo Paglioli, Ligia Coutinho, Sergio Raupp, Jo[atilde]o-Rubi[atilde]o Hoefel Filho. Porto Alegre Epilepsy S
RATIONALE: Early consideration of functional hemispherectomy is gaining acceptance in children and adolescents with catastrophic epilepsies associated with predominantly unilateral hemispheral epileptogenic lesions. The role of the specific etiology and of the preoperative EEG findings in anticipating prognosis is, however, still debatable.
We wanted to analyze seizure and global outcomes in general and in relation to etiological diagnoses and preoperative EEG findings in a consecutive series of patients undergoing functional hemispherectomy for hemispheral catastrophic epilepsies.
METHODS: Medical records and surgical outlines were reviewed, and personal or structured telephonic interviews were performed to evaluate etiological diagnosis, clinical and electrographic variables, and surgical outcome. Four patients had, respectively, non-hemimegalencephalic hemispheral malformations of cortical development (NHMCD), encephalomalacia (EMC), and Rasmussen[scquote]s encephalitis (Ras), while there were 3 with hemimegalencephaly (HMG) and 3 with Sturge-Weber disease (SWD).
RESULTS: Overall, 10 of 15 (66%) and 5 of 8 (63%) patients were seizure free (Engel[scquote]s class I) at years 1 and 2 after operation, respectively. At year 1, 1/3 (33%) patients with NHMCD, 1/2 (50%) with HMG, 1/2 (50%) with SWD, 3/4 (75%) with EMC, and 4/4 (100%) with Ras were seizure free. In the latest analysis, 13/15 patients (86%) were considered as globally improved by their parents and teachers. Contralateral EEG epileptogenic discharges were present in 6/9 (66%) of those patients who were seizure free at year 1, and in 3/4 (75%) of those who had persistent attacks (difference not statistically significant).
CONCLUSIONS: Hemispherectomy for hemispheral catastrophic childhood epilepsies can bring forth significantly favorable results, irrespective of the presence of bilateral EEG abnormalities. Favorable results can be achieved in all etiological groups, although Ras and EMC are more frequently associated with seizure freedom.
[Supported by: FAPERGS]