Bajaj Alliance Centre for Epilepsy, Deenanath Mangeshkar Hospital, Room No 705, A wing, 7th Floor, Old Building, Erandwane, Pune, India, 411004.
Neoclinic Children's Hospital, Jaipur, India.
Childs Nerv Syst. 2024 Feb;40(2):503-509. doi: 10.1007/s00381-023-06151-4. Epub 2023 Sep 12.
Present study attempted to analyze seizure freedom and detailed functional outcomes after functional hemispherotomy and utility of hemispherotomy outcome prediction scale (HOPS) scores in predicting outcomes.
Patients who underwent functional hemispherotomy were analyzed for clinical presentation, neuroimaging, seizure outcomes, and functional outcomes.
A total of 76 procedures were performed on 69 patients. Mean age at the surgery was 8 ± 6.1 years. Fourteen patients were < 2 years. Age of onset epilepsy of the cohort was 2.0 ± 3.3 years. All had severe catastrophic epilepsy with multiple daily seizures. All patients had motor deficits with 36 (52%) patients had contralateral dysfunctional hand. Perinatal stroke (49%) was most common substrate followed by cortical malformations (21.7%). Eight patients had contralateral imaging abnormalities. Fifty-nine (86.76%) patients remained seizure free (Engle 1a) at 41 + -20.9 months. HOPS scores were available for 53 patients and lowest seizure outcome was 71% for HOPS score of 4. Lower HOPS scores predicted better seizure outcomes. Cortical malformations operated earlier than 2 years predicted poor seizure outcomes (66.6%). Positive functional outcomes are recorded in 80% of patients with 78% reporting improvement from the pre-surgical level. Five (7.2%) patients underwent shunt surgery. One mortality recorded.
Hemispherotomy has excellent seizure outcomes. Early surgery in cortical malformations appears to be predictor of poorer seizure outcomes. HOPS score is a good tool to predict the seizure outcomes. Hemispherotomy is perceived to improve the Cognitive and functional performance.
本研究旨在分析功能半球切开术后的无癫痫发作率和详细的功能结果，并探讨半球切开术结果预测量表（HOPS）评分在预测结果中的作用。
对接受功能半球切开术的患者进行临床特征、神经影像学、癫痫发作结果和功能结果分析。
共对 69 例患者的 76 例手术进行了分析。手术时的平均年龄为 8±6.1 岁。14 例患者年龄<2 岁。该队列的癫痫发病年龄为 2.0±3.3 岁。所有患者均患有严重的灾难性癫痫，每日发作多次。所有患者均有运动障碍，其中 36 例（52%）患者有对侧功能障碍手。最常见的病因是围产期卒中（49%），其次是皮质畸形（21.7%）。8 例患者对侧有影像学异常。59 例（86.76%）患者在 41±-20.9 个月时仍无癫痫发作（Engle 1a）。53 例患者有 HOPS 评分，HOPS 评分为 4 分的患者最低癫痫发作率为 71%。较低的 HOPS 评分预示着更好的癫痫发作结果。皮质畸形患者在 2 岁之前接受手术，其癫痫发作结果较差（66.6%）。80%的患者功能预后良好，78%的患者报告术后功能较术前改善。5 例（7.2%）患者行分流术。记录到 1 例死亡。
半球切开术具有良好的癫痫发作结果。皮质畸形的早期手术似乎是癫痫发作结果较差的预测因素。HOPS 评分是预测癫痫发作结果的良好工具。半球切开术被认为可以改善认知和功能表现。
