[HEMISPHEROTOMY FOR TREATMENT OF REFRACTORY EPILEPSY IN CHILDREN].

INTRODUCTION

Hemispherotomies are an extreme treatment for epilepsy. As opposed to focal resections, in hemispherotomies the entire hemisphere is disconnected from the remaining nervous system, including functional regions and fibers. Despite this, hemispherotomy is recommended for certain indications, with good epilepsy and functional outcomes.

AIMS

To summarize the experience of hemispherotomy performed at a tertiary national center.

METHODS

A retrospective study was conducted including all patients operated on between 2001 and 2014. Patients were 10 months to 18 years old at the time of surgery, and all underwent hemispherotomy for treatment of refractory epilepsy.

RESULTS

A total of 14 children were included in the study. The main etiology for epilepsy included Rasmussen encephalitis (5), hemispheral cortical dysplasia (3), and ischemic stroke (2). Six children had previous surgeries. All children underwent peri-insular hemispherotomy. One child lives abroad and was lost to follow-up. Of the remaining 13: 9 are seizure-free since surgery, 3 have rare seizures and 1 has frequent seizures (however, less than preoperatively). The average number of antiepileptic drugs was reduced by about 50%. All children had neurological deficits similar to their preoperative status, or had gradual improvement in motor and cognitive/linguistic skills. There was one complication - an infection that had no neurological impact, but necessitated surgical wound revision.

CONCLUSIONS

Hemispherotomy changes the natural history of refractory hemispheric epilepsy. The epilepsy and functional outcomes are good.

DISCUSSION

Hemispherotomy surgery is part of the treatment options for children with refractory hemispheric epilepsy. Despite the hemispheric disconnection, functional outcome is encouraging. The degree of functional outcome depends on preoperative neurological injury, thus it is important not to delay surgery if indicated.