Abstracts

Rationale: The purpose of our study was to compare the seizure reduction and co-morbidities associated with anatomical (AH) and functional hemispherectomy (FH) in children with Rasmussen s Encephalitis (RE).Methods: We retrospectively reviewed patients who had AH and FH from January 2003 to May 2011, and identified patients with RE, based on clinical and pathological criteria outlined in the 2005 European Consensus (Bien CG, et. al., 2005). Results: We reviewed the identified 78 patients who had AH and FH during the study period, and 8(11%) patients were identified with RE based on the criteria. Of the 8 patients who had hemispherectomy as treatment for RE, 4 had AH (50%) and 4 had FH (50%). All patients had Engel Class 1 seizure outcome after surgery as there were no electroclinical seizures in any subject. However, 1 FH patient had electrographic seizures and auras within the first 6 months after surgery. All patients had improvement in cognition as evidenced by return to grade level or based on neurological examination. While there were no epileptiform discharges (ED) seen in patients after AH, 2 of the FH patients had EDs. For complications, 3 of the AH patients developed hydrocephalus and required placement of ventriculoperitoneal (VP) shunts. Three AH patients required botulinum toxin injections and one required orthotic equipment for spasticity. None of the FH patients required VP shunts or procedures for spasticity. All patients who had FH and AH had hemiparesis prior to and after surgery. All of the AH patients had their AEDs discontinued while only 1 FH patient was tapered off medication. Post-operative MRI findings in patients with FH are limited to disconnected hemispheres with no contralateral spread of epileptiform discharges. Conclusions: From our experience with a small group of patients with RE, FH can be as effective as AH in controlling electroclinical seizures, without associated comorbitidies such as hydrocephalus and potentially with less spasticity. With such favorable factors, FH appears to a more favorable technique of choice in patients requiring hemispherectomy, even in an inflammatory condition such as RE.