Document Detail

Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children.
MedLine Citation:
PMID:  23223541     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Data on longitudinal seizure outcome after hemispherectomy in children are limited. This study explores the posthemispherectomy longitudinal seizure outcome and its predictors. METHODS: We reviewed 186 consecutive children who underwent hemispherectomy between 1997 and 2009 at our center. Clinical, EEG, imaging, and surgical data were collected. Seizure outcome data were collected via a structured questionnaire by contacting families (n = 125) or from the medical records at last follow-up (n = 58). RESULTS: Of 186 patients, 3 were lost to follow-up; 13 seizure-free patients with new-onset nonepileptic spells were excluded. Perioperative complications were not collected. There was no mortality. At a mean follow-up of 5.3 years (±3.3 years), 112 of 170 children (66%) were seizure-free (Engel class 1a). In 58 patients with seizure recurrence, 8 had late remission and 16 had >90% reduction. Overall, at last follow-up, 136 patients (80%) were either seizure-free or had major improvement. Using survival analysis, the estimated probability of seizure freedom after hemispherectomy was 78% (95% confidence interval [CI] = 75%-81%) at 6 months, 76% (95% CI = 73%-79%) at 1 year, 71% (95% CI = 68%-74%) at 2 years, and 63% (95% CI = 59%-67%) at 5 years. On multivariate analysis, bilateral PET abnormalities (risk ratio = 2.53, 95% CI = 1.02-5.85) and acute postoperative seizures (risk ratio = 7.03, 95% CI = 3.07-15.9) independently predicted seizure recurrence. CONCLUSIONS: The long-term seizure-free rates after hemispherectomy remained stable at 63% at 5 years and beyond. This study will assist in better candidate selection for hemispherectomy, presurgical counseling, and early identification of surgical failures.
Ahsan N V Moosa; Ajay Gupta; Lara Jehi; Ahmad Marashly; Gary Cosmo; Deepak Lachhwani; Elaine Wyllie; Prakash Kotagal; William Bingaman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-5
Journal Detail:
Title:  Neurology     Volume:  -     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Departments of Neurology (A.N.V.M., A.G., L.J., A.M., G.C., D.L., E.W., P.K.) and Neurosurgery (W.B.), Section of Pediatric Epilepsy, Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
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