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Vol. 33. Issue 2.
Pages 82-89 (March - April 2022)
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Vol. 33. Issue 2.
Pages 82-89 (March - April 2022)
Clinical Research
Long term outcome of functional hemispherectomy for refractory epilepsy: Experience from a single center
Resultado a largo plazo de la hemisferectomía funcional para la epilepsia refractaria: experiencia en un único centro
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Sérgio Sousaa,b,1,
Corresponding author
sergioalvesdesousa7@gmail.com

Corresponding author.
, Vasco Sá Pintoa,b,1, João Chavesa,c,f, António Martins da Silvaa,d,f, João Ramalheiraa,d, João Lopesa,d, Teresa Temudoa,e, José Manuel Lopes Limaa, Alfredo Calheirosb, Rui Rangela,b
a Epilepsy Unit, Porto Epicare Centre for Refractory Epilepsy, Centro Hospitalar Universitário do Porto, Portugal
b Neurosurgery, Neurosciences Department, Centro Hospitalar Universitário do Porto, Portugal
c Neurology, Neurosciences Department, Centro Hospitalar Universitário do Porto, Portugal
d Neurophysiology, Neurosciences Department, Centro Hospitalar Universitário do Porto, Portugal
e Neuropediatrics Department, Centro Hospitalar Universitário do Porto, Portugal
f UMIB/ICBAS – University of Porto, Porto, Portugal
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Figures (1)
Tables (5)
Table 1. Demographic data for all patients.
Table 2. Etiology, seizure frequency and type and antiepileptic drug regimen individualized for all patients.
Table 3. Evolution of Engel classification for each patient.
Table 4. Post-operative complications described for each patient.
Table 5. This table demonstrates the changes in AED regimen throughout follow-up.
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Abstract
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 Epilepsy Unit. We compared the seizure outcome at 6 months, 1, 2, 5 years post-surgery, as well as at end follow-up (mean 7.1 years) using Engel classification. Reduction of antiepileptic drugs (AEDs) was also assessed utilizing equal time frames.

Results

The mean age of seizure onset was 5.4 years. Engel I was achieved in 5 patients at 6 months (71.4%). 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. Engel at 2 years was also predicted by Engel at 6 months and at 1 year (p=0.030). At end follow-up only 3 patients (42.9%) remained categorized as Engel I outcome. There was a trend toward a stability in Engel classification. All patients with developmental causes for their epilepsy experienced some deterioration of the surgical outcomes. Conversely, all patients with acquired causes were stable throughout follow-up. Seizure outcome at 6 months was worse in the patients who had post-op complications (p=0.044). Adult and pediatric populations did not differ significantly in any tested variable.

Conclusions

Hemispherectomy is a valuable resource for seizure control in properly selected patients. Engel patient's evolution could be predicted at 6 months interval. Hemispherectomy could be considered a useful attitude in difficult cases.

Keywords:
Epilepsy surgery
Hemispherectomy
Refractory epilepsy
Resumen
Antecedentes

La hemisferectomía tiene un rol establecido como último recurso de tratamiento en pacientes con lesiones hemisféricas unilaterales que padecen epilepsia refractaria.

Métodos

En nuestra Unidad de Epilepsia fueron evaluados 7 pacientes. Comparamos el resultado de la crisis epiléptica a los 6 meses, 1, 2 y 5 años posteriores a la cirugía, así como durante el seguimiento final (media 7,1 años) utilizando la clasificación de Engel. También se evaluó la reducción de fármacos antiepilépticos (FAE) utilizando marcos temporales iguales.

Resultados

La edad media de aparición de la crisis fue de 5,4 años. Se logró Engel I en 5 pacientes a los 6 meses (71,4%). Engel a 1año fue predicho por Engel a 6 meses (p=0,013) con un número similar de pacientes clasificados como resultado Engel I. Engel a 2 años fue también predicho por Engel a 6 meses y 1año (p=0,030). Durante el seguimiento final solo 3 pacientes (42,9%) siguieron categorizados como resultado Engel I. Se produjo una tendencia hacia la estabilidad en la clasificación Engel. Todos los pacientes con causas evolutivas para la epilepsia experimentaron cierto deterioro de los resultados quirúrgicos. Por contra, todos los pacientes con causas adquiridas permanecieron estables a lo largo del seguimiento. El resultado de las crisis a los 6 meses fue peor en los pacientes con complicaciones posquirúrgicas (p=0,044). Las poblaciones adulta y pediátrica no difirieron significativamente en ninguna de las variables probadas.

Conclusiones

La hemisferectomía es un recurso válido para el control de la crisis en pacientes debidamente seleccionados. La evolución del paciente de Engel pudo predecirse a intervalos de 6 meses. La hemisferectomía podría considerarse una actitud útil en casos difíciles.

Palabras clave:
Cirugía de la epilepsia
Hemisferectomía
Epilepsia refractaria

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