| Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children. | |
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MedLine Citation:
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PMID: 23223541 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Ahsan N V Moosa; Ajay Gupta; Lara Jehi; Ahmad Marashly; Gary Cosmo; Deepak Lachhwani; Elaine Wyllie; Prakash Kotagal; William Bingaman |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-12-5 |
Journal Detail:
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Title: Neurology Volume: - ISSN: 1526-632X ISO Abbreviation: Neurology Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-12-10 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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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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