Elsevier

Seizure

Volume 30, August 2015, Pages 70-75
Seizure

Improvement of language development after successful hemispherotomy

https://doi.org/10.1016/j.seizure.2015.05.018Get rights and content
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Highlights

  • Multilobar/hemispheric epilepsy is associated with severe encephalopathy.

  • Vertical hemispherotomy results in seizure-freedom and developmental progress.

  • The long post-operative follow-up revealed a slow developmental progress.

  • The study proves that severe handicapped children benefit from epilepsy surgery.

Abstract

Purpose

To investigate language development after functional hemispherotomy and to evaluate prognostic factors for (un-)favourable outcomes.

Methods

Children and adolescents who had vertical perithalamic hemispherotomy at the Medical University Wien (MUW) paediatric epilepsy centre were identified from a prospectively maintained database. Inclusion criteria were: complete clinical, neurophysiological and neuropsychological data, seizure freedom and a minimum follow-up of 12 months after surgery. The language quotients (LQ) prior to surgery and at last follow-up were calculated for each child. In addition, associations between pre- to post-surgical changes in LQ and the following variables were examined: age at epilepsy-onset, age at surgery and duration of epilepsy prior to surgery, aetiology, side of surgery, interictal EEG including sleep organization before and 12 months after surgery and antiepileptic-drug (AED) withdrawal state at last follow-up. Analyses were carried out in SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Nonparametric Wilcoxon and chi-square tests were applied, as required.

Results

Data from 28 children (14 female) were analyzed. The median age at epilepsy surgery was 64.5 months. The median follow-up after surgery was 3.0 years (±2.6 years, range 12 months to 12 years). Significant gains in LQs at last follow-up were found in 31% of the children (p = 0.008). Short disease duration prior to surgery, acquired pathology, lack of epileptiform EEG discharges in the contralateral hemisphere and/or normalization of EEG sleep patterns after surgery, and successful AED withdrawal were linked to favourable language outcomes.

Conclusion

Successful and early hemispherotomy results in improvement of language function in the intact hemisphere.

Abbreviations

LQ
language quotient
ESES
electrical status epilepticus in sleep
PMG
polymicrogyria
FCD
focal cortical dysplasia
SWS
Sturge–Weber syndrome
RE
Rasmussen encephalitis
MCD
mild cortical dysplasia

Keywords

Epilepsy surgery
Children
Language developmental

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