Abstracts

Rationale: To determine the outcome of children with Rasmussen encephalitis (RE) treated with hemispherectomy and receiving a 12 week intensive inpatient rehabilitation programme. Methods: Case note review with regard to pre-surgical status and outcome following a 12 week intensive inpatient rehabilitation programme and at last follow up. Results: The case notes of seven children (4 male,3 female) were reviewed;median age at hemispherectomy 13 years (range 8.8-15.4 years). The median duration of seizures prior to surgery was 6 years (1.2-7.9 years). In all 7 cases pre-surgical assessments suggested language dominance in the left hemisphere. The dominant hemisphere was involved with RE in four cases. In three cases there was some evidence of re-organisation of language (neuropsychology and FMRI). Two cases required a further disconnection procedure for re-emergence of seizures (one developed hydrocephalus). Six were seizure free at last follow up. Following hemispherectomy there was improvement in: seizure control, antiepileptic drug load, mobility, activities of daily living and access to education. Comparing the status pre- and post-surgery and following rehabilitation there was most improvement in motor and self care skills. At follow up there was maintained improvement in seizure control and improvement in ambulation and in accessing education and school attendance. Conclusions: Surgery improves seizure control in RE and longer term access to education. Children undergoing intensive post surgical rehabilitation benefit with regard to motor skills, ambulation and self care skills in the short term. Intensive post surgical rehabilitation is recommended as routine management for these patients with complex and multidimensional needs.