LONG-TERM OUTCOMES OF HEMIDECORTICATION IN CHILDREN
Abstract number :
3.231
Submission category :
Year :
2002
Submission ID :
41
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Eric H. Kossoff, Diana J. Pillas, Margaret B. Pulsifer, Eileen P. Vining, John M. Freeman. Neurology and Pediatrics, The Pediatric Epilepsy Center, The Johns Hopkins Medical Institutions, Baltimore, MD
RATIONALE: Hemidecortication has been performed for several decades to treat intractable unihemispheric epilepsy. A prior case series focused on the outcomes after 58 surgeries at our institution in 1997. At the end of this activity the participants should be able to discuss the long-term outcomes of hemidecortication.
METHODS: Charts were reviewed and families were contacted of the 106 hemidecortications performed by the Pediatric Epilepsy Center from 1975 to 2001. Follow-up ranged from 6 months to 22 years. Three children were unavailable for follow-up. Pre- and post-operative neuropsychological test results were available for 53 subjects, with a mean interval between surgery and most recent evaluation of 5.4 years (SD = 5.05).
RESULTS: 3 children died in the immediate perioperative period; two children died several years later due to intractable seizures. Overall, 63% are seizure-free, 22% have occasional, non-handicapping seizures, and 15% have residual, troublesome seizures. The average patient is on 0.67 medications and has 89% improvement in seizure frequency. 88% of patients are able to walk without assistance. 63% of patients with Rasmussen[scquote]s and 79% of those with congenital strokes were seizure-free, compared to 50% of those with cortical dysplasias (40% of hemimegalencephaly specifically). The overall mean pre-surgical IQ was 68 (SD = 27) and follow-up IQ was 65.9 (SD = 25). IQ change was not significantly related to etiology of seizures (Rasmussen[ssquote]s/cortical dysplasia) or to side of surgery. The most significant predictor of IQ at follow-up was pre-surgical IQ.
CONCLUSIONS: Hemidecortication continues to be a beneficial procedure in reducing seizure frequency in cases of unilateral cortical epilepsy. The large majority of children have both seizure and medication reduction without major impact on ambulation. Children with Rasmussen[scquote]s syndrome and congenital strokes had a better response than those with dysplasias. There was no change in IQ after surgery, nor was change in IQ related to etiology.
REFERENCES:
Vining EPG, Freeman JM, Pillas DJ, Uematsu S, et. al. Why would you remove half a brain? The outcome of 58 children after hemispherectomy[mdash]The Johns Hopkins Experience: 1968-1996. Pediatrics 1997; 100: 163-171.
[Supported by: This study was supported in part by funds for the Roxanne Fellowship.]