Long term outcome of functional hemispherectomy for refractory epilepsy: Experience from a single center |
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| Institution: | 1. Epilepsy Unit, Porto Epicare Centre for Refractory Epilepsy, Centro Hospitalar Universitário do Porto, Portugal;2. Neurosurgery, Neurosciences Department, Centro Hospitalar Universitário do Porto, Portugal;3. Neurology, Neurosciences Department, Centro Hospitalar Universitário do Porto, Portugal;4. Neurophysiology, Neurosciences Department, Centro Hospitalar Universitário do Porto, Portugal;5. Neuropediatrics Department, Centro Hospitalar Universitário do Porto, Portugal;6. UMIB/ICBAS – University of Porto, Porto, Portugal;1. Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España;2. Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España;3. Neurofisiología Clínica, Servicio de Neurología, Hospital Universitario La Paz, Madrid, España;1. Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España;2. Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, España;3. Universidad de la Rioja , Logroño, España;4. Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Sureste, Madrid, España;1. Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey;2. Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey;3. Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey;4. Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey;1. Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain;2. Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain;3. Department of Neurosurgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain;1. Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain;2. Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;3. Department of Endocrinology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;4. Department of Otorhinolaryngology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;5. Department of Pathologic Anatomy, Hospital Universitario Marqués de Valdecilla, Santander, Spain;6. Department of Neurorradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain |
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| Abstract: | BackgroundHemispherectomy has an established role as a treatment of last resort in patients with unilateral hemispheric lesions suffering from refractory epilepsy.MethodsSeven patients were evaluated at our Epilepsy Unit. We compared the seizure outcome at 6 months, 1, 2, 5 years post-surgery, as well as at end follow-up (mean 7.1 years) using Engel classification. Reduction of antiepileptic drugs (AEDs) was also assessed utilizing equal time frames.ResultsThe mean age of seizure onset was 5.4 years. Engel I was achieved in 5 patients at 6 months (71.4%). Engel at 1 year was predicted by the Engel at 6 months (p = 0.013) with a similar number of patients being classified as Engel I outcome. Engel at 2 years was also predicted by Engel at 6 months and at 1 year (p = 0.030). At end follow-up only 3 patients (42.9%) remained categorized as Engel I outcome. There was a trend toward a stability in Engel classification. All patients with developmental causes for their epilepsy experienced some deterioration of the surgical outcomes. Conversely, all patients with acquired causes were stable throughout follow-up. Seizure outcome at 6 months was worse in the patients who had post-op complications (p = 0.044). Adult and pediatric populations did not differ significantly in any tested variable.ConclusionsHemispherectomy is a valuable resource for seizure control in properly selected patients. Engel patient's evolution could be predicted at 6 months interval. Hemispherectomy could be considered a useful attitude in difficult cases. |
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| Keywords: | Epilepsy surgery Hemispherectomy Refractory epilepsy Cirugía de la epilepsia Hemisferectomía Epilepsia refractaria |
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