Department of Neurology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands.
Epilepsy Res. 2013 Feb;103(2-3):221-30. doi: 10.1016/j.eplepsyres.2012.08.007. Epub 2012 Sep 11.
Prediction of functional motor outcome after hemispherectomy is difficult due to the heterogeneity of motor outcomes observed. We hypothesize that this might be related to differences in plasticity during the onset of the underlying epileptogenic disorder or lesion and try to identify predictors of motor outcome after hemispherectomy. Thirty-five children with different etiologies (developmental, stable acquired or progressive) underwent functional hemispherectomy and motor function assessment before hemispherectomy and 24 months after hemispherectomy. Preoperatively, children with developmental etiologies performed better in terms of distal arm strength and hand function, but not on gross motor function tests. Postoperatively, the three etiology groups performed equally poor in muscle strength and hand function, but gross motor function improved in those with acquired and progressive etiologies. Loss of voluntary hand function and distal arm strength after surgery was associated with etiology, intact insular cortex and intact structural integrity of the ipsilesional corticospinal tract on presurgical MRI scans. In conclusion, postoperative motor function can be predicted more precisely based on etiology and on preoperative MRI. Children with developmental etiology more often lose distal arm strength and hand function and show less improvement in gross motor function, compared to those with acquired pathology.
由于观察到的运动结果存在异质性，因此很难预测半球切除术的功能运动结果。我们假设这可能与潜在致痫性疾病或病变开始时的可塑性差异有关，并试图确定半球切除术的运动结果的预测因素。35 名具有不同病因（发育性、稳定获得性或进行性）的儿童在接受半球切除术之前和之后 24 个月接受了功能半球切除术和运动功能评估。术前，发育性病因的儿童在远端手臂力量和手功能方面表现更好，但在粗大运动功能测试中表现不佳。术后，三组病因患儿的肌肉力量和手功能同样较差，但获得性和进行性病因患儿的粗大运动功能有所改善。术后自愿手功能和远端手臂力量丧失与病因、术前 MRI 扫描上岛叶皮质完整和同侧皮质脊髓束结构完整有关。总之，术后运动功能可以更准确地基于病因和术前 MRI 进行预测。与获得性病变相比，发育性病因的儿童更常失去远端手臂力量和手功能，且粗大运动功能改善较少。
