Rudolf Magnus Institute of Neuroscience, Department of Child Neurology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
Neurology. 2010 Nov 2;75(18):1623-30. doi: 10.1212/WNL.0b013e3181fb4400.
To explore whether EEG and MRI abnormalities in the "healthy" hemisphere influence seizure and cognitive outcome after functional hemispherectomy.
This is a retrospective consecutive cohort study of 43 children who underwent functional hemispherectomy between 1994 and 2008. Results of preoperative EEG recordings were reviewed for the existence of (inter)ictal epileptic or background abnormalities in the contralateral hemisphere. Preoperative MRIs were reexamined for the existence of unequivocal contralateral abnormalities. Postoperative seizure status was assessed, and of 34 children, IQ or mental developmental index (MDI) scores were obtained preoperatively and postoperatively. Seizure freedom was defined as Engel 1A. Contralateral EEG and MRI abnormalities were studied in relation to seizure and cognitive outcome.
Thirty-three children achieved seizure freedom (77%). Of the 11 patients with contralateral MRI abnormalities, only 45% were seizure free, compared with 88% of the 32 patients without contralateral MRI lesions (p = 0.030). Children with contralateral MRI abnormalities more often were severely retarded after surgery (MDI/IQ <55; 90% vs 42%, p = 0.030). Postoperative MDI/IQ scores improved in none of the children with, but in 38% of those without contralateral MRI abnormalities (p = 0.034). Contralateral epileptic or background EEG abnormalities did not affect seizure outcome or postoperative cognitive performance. Four of 6 children with bilateral epileptic encephalopathy reached seizure freedom.
Unambiguous contralateral MRI abnormalities are significantly associated with seizure recurrence, severe mental delay, and lack of cognitive improvement and may be considered a relative contraindication for hemispherectomy. Contralateral EEG abnormalities do not negatively influence postsurgical outcome.
探讨“健康”半球的脑电图（EEG）和磁共振成像（MRI）异常是否会影响功能半球切除术（functional hemispherectomy）后的癫痫发作和认知结局。
这是一项回顾性连续队列研究，纳入了 1994 年至 2008 年间接受功能半球切除术的 43 名儿童。回顾术前 EEG 记录以评估对侧半球是否存在（间）发性癫痫或背景异常。重新检查术前 MRI 以确定是否存在明确的对侧异常。评估术后癫痫发作情况，对 34 名儿童，获取术前和术后的智商（IQ）或精神发育指数（MDI）评分。癫痫无发作定义为恩格尔 1A 级。研究了对侧 EEG 和 MRI 异常与癫痫发作和认知结局的关系。
33 名儿童达到癫痫无发作（77%）。在 11 名有对侧 MRI 异常的患者中，仅有 45%达到癫痫无发作，而在 32 名无对侧 MRI 病变的患者中为 88%（p=0.030）。术后有对侧 MRI 异常的儿童更常出现严重智力迟钝（MDI/IQ<55；90% vs 42%，p=0.030）。术后 MDI/IQ 评分在无对侧 MRI 异常的儿童中无一例改善，但在有对侧 MRI 异常的儿童中有 38%改善（p=0.034）。对侧癫痫或背景 EEG 异常并不影响术后癫痫发作或认知表现。6 名双侧癫痫性脑病儿童中有 4 名达到癫痫无发作。
明确的对侧 MRI 异常与癫痫复发、严重智力迟钝以及认知改善缺乏显著相关，可能被视为半球切除术的相对禁忌证。对侧 EEG 异常不会对术后结局产生负面影响。
