Functional Hemispherectomy for uncontrollable epilepsy: seizure control in challenging cases
Author(s): ,
S. Sousa
Hospital de Santo António, Neurosurgery, Porto, Portugal
V. Sá Pinto
Hospital de Santo António, Neurosurgery, Porto, Portugal
R. Rangel
Hospital de Santo António, Neurosurgery, Porto, Portugal
EANS Academy. Sousa S. 10/21/18; 226018; EP7011
Dr. Sérgio Sousa
Dr. Sérgio Sousa
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Hemispherectomy has an established role as a treatment of last resort in patients with unilateral hemispheric lesions suffering from refractory epilepsy.

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.

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).

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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