OUTCOME AFTER HEMISPHERECTOMY IN ADULTS WITH REFRACTORY HEMIPLEGIC EPILEPTIC SYNDROMES
A Cukiert, JA Burattini, PP Mariani, CM Cukiert, C Baise-Zung, M Argentoni-Baldochi, CR Forster, VA Mello.
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo SP, Brazil
Hemispherectomy is an extremely effective surgical procedure usually performed in children with Rasmussen encephalitis, hemispheric cortical dysplasia, hemimegaloencephaly, congenital or acquired hemiplegic epileptic syndromes or Sturge-Weber. Hemispherectomy is certainly an underused surgical procedure and many kids with refractory hemiplegic epileptic syndromes grow and are left without adequate treatment until adulthood. We report on our results obtained after hemispherectomy performed in adult patients with refractory hemiplegic epileptic syndromes.
Fourteen patients were studied. Age ranged from 17 to 34 years (mean = 23 years). All patients had refractory hemiplegic epileptic syndromes. Daily unilateral simple partial motor seizures were present and prevailed in every patient. Complex partial seizures and tonic-clonic seizures were also present in 11 patients. MRI showed a gross hemispheric congenital lesion prevailing over the middle cerebral artery territory in all patients. Interictal EEG showed spiking restricted to the damaged side in 8 patients, bilateral synchrony in 2 patients, discharges prevailing over the non-damaged hemisphere in 2 patient and exclusively healthy hemisphere spiking in 2 patients. All patients were submitted to functional hemispherectomy. Follow up time ranged from 1 to 11 years (mean = 50 months).
All patients underwent uneventful procedures. Six patients had an aseptic meningitis syndrome (headache, neck stiffness and fever) that needed no antibiotic treatment. All patients were seizure free one year after surgery. Two patients, who had unilateral preoperative EEG findings, had 2 and 3 generalized tonic-clonic seizures during the first postoperative month, respectively. The antiepileptic drugs were successfully reduced in all patients, and 5 patients were taking no drugs at last follow-up.
Functional hemispherectomy is highly effective in this adult patient population. Although effective in all age strata, this procedure should not be delayed; all these adult patients might have been good surgical candidates earlier in life.