Long-term follow-up of children who underwent hemispherectomy for refractory epilepsy showed that in most cases, the patients stopped having seizures and were able to move independently, but various speech, cognitive, behavioral disorders and problems with performing tasks necessary in daily life were often observed,. net During the follow-up of 115 children (mean age at the start of the study 6.05 years), it turned out that 70 of them did not experience seizures after surgery, 96 were able to walk without support. But 2/3 of children after hemispherectomy had at least a slight speech impairment, about 85% required special conditions of education or training in a special school.
Among children over 6 years old, only 18% retained their age-appropriate reading abilities.. This was reported to the online edition of Epilepsia by Dr. Ajay Gupta from the Cleveland Clinic (Ohio).
The worst outcomes in terms of walking, speech, reading and behavior were observed in the group in which epileptic seizures recurred after surgery.. In addition, motor impairment after surgery was often associated with abnormalities in the unoperated hemisphere on MRI (P video EEG, radiological findings, surgical reports, records of pre-existing neurological deficits)..
Participants - parents or guardians, and in some cases the patients themselves - were interviewed for several years after the operation.. They completed questionnaires assessing functional outcomes, including children's day-to-day skills, their academic performance, etc.. In the questionnaire, the assessment of parameters was binary - “good” or “bad”, and about walking there were three options: the child walks independently, is able to walk several steps without support, or cannot walk.
The mean duration of follow-up was 6 years. Note that 85% of children who underwent hemispherectomy developed epilepsy before the age of 3 years..
At the end of follow-up, 61% of patients did not have epileptic seizures.. Late remission was achieved in 7% of cases, in 13% of cases it was possible to achieve a reduction in the frequency of seizures by more than 90%. In 19% of children after surgery, the frequency of epileptic seizures decreased by less than 90% (the minimum result is a decrease in the frequency of seizures by only 9%).
Among already adult patients, 5 out of 24 were employed and lived independently. School-aged patients were generally able to study in a general school, 6.2% were self-taught and 59.2% required special assistance; 27.2% of children were forced to study in special schools for the disabled. At the same time, 7.4% of patients were "
Multivariate analysis showed that the following factors were associated with impaired ability to walk after hemispherectomy (P\u003c0.05):.
• Structural anomalies in the unoperated hemisphere, confirmed by MRI.
• Pre-existing bilateral motor deficit.
• Resumption of epileptic seizures after surgery.
Speech deficit after surgery is most dependent on such factors:.
• Structural anomalies in the unoperated hemisphere (OR 13.98; 95% CI 2.77-90.37).
• Uncertain speech status before surgery (OR 11.16; 95% CI 1.55-230.57).
• Recurrent epileptic seizures after surgery (OR 3.18; 95% CI 0.99-10.19).
Poor reading ability after hemispherectomy was determined by the following factors:.
• Cortical anomalies in the unoperated hemisphere (OR 24.07; 95% CI 2.24-764.73).
• Recurrent epileptic seizures after surgery (OR 5.00; 95% CI 1.55-18.59).
• Earlier age of onset of epilepsy (OR not given).
Dr. Gupta and colleagues identified several limitations that may have affected the reliability of the results of the study: the young age of the patients, the subjectivity of parents and guardians in the assessment, the excessive simplicity of the questionnaire, and the possible presence of clinical factors that were not identified at examination but influenced the outcome..
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