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Functional Hemispherectomy for uncontrollable epilepsy: seizure control in challenging cases
Author(s): ,
S. Sousa
Affiliations:
Hospital de Santo António, Neurosurgery, Porto, Portugal
,
V. Sá Pinto
Affiliations:
Hospital de Santo António, Neurosurgery, Porto, Portugal
R. Rangel
Affiliations:
Hospital de Santo António, Neurosurgery, Porto, Portugal
EANS Academy. Sousa S. Oct 21, 2018; 226018; EP7011
Dr. Sérgio Sousa
Dr. Sérgio Sousa
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Abstract
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Background:
Hemispherectomy has an established role as a treatment of last resort in patients with unilateral hemispheric lesions suffering from refractory epilepsy.

Methods:
Seven patients were evaluated at our Neurological Surgery Unit. We compared the seizure outcome at 6 months and at 1 year post-surgery, as well as at end follow-up (mean 63 months) using Engel classification. Reduction of antiepileptic drugs (AEDs) was also assessed utilizing equal time frames.

Results:
The mean age of seizure onset was 5 years. Engel I was achieved in 5 patients at 6 months (71.4%), all of whom were free of seizures. 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. At end follow-up only 3 patients (42.9%) remained categorized as Engel I outcome. All others were ascribed to Engel class IV class. An Engel class I at 6 months is associated with less seizure recurrence at end follow-up (p=0,006). Pediatric patients had less post-op complications (p= 0.03) and had significantly less seizure prevalence than adult patients at 6 months after surgery (p=0.008), but not at 1 year nor at end follow-up. Seizure outcome at 6 months was worse in the patients who had post-op complications (p=0.03). There were significantly less post-op complications in the patients who had a higher seizure frequency pre-op (p=0.042). AEDs were reduced in 5 patients at 6 months, 4 patients at 1 year and in 3 patients at end follow-up. AEDs dosage reduction was associated with the Engel classification at 6 months (p=0.008) and, in those in which AEDs were reduced, there was less probability of recurrence (p=0,021).

Conclusions:
Hemispherectomy is a valuable resource for seizure control in properly selected patients. It should be considered as a useful weapon in difficult cases.
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