Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients

Robert A. McGovern; Ahsan N. V. Moosa; Lara Jehi; Robyn Busch; Lisa Ferguson; Ajay Gupta; Jorge Gonzalez-Martinez; Elaine Wyllie; Imad Najm; William E. Bingaman

doi:10.1111/epi.16378

Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients

Robert A. McGovern, Ahsan N. V. Moosa, Lara Jehi, Robyn Busch, Lisa Ferguson, Ajay Gupta, Jorge Gonzalez-Martinez, Elaine Wyllie, Imad Najm, William E. Bingaman

Neurosurgery

Research output: Contribution to journal › Article › peer-review

42 Scopus citations

Abstract

Objective: To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents. Methods: We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed. Results: Thirty-six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow-up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6-month follow-up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes. Significance: Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.

Original language	English (US)
Pages (from-to)	2416-2427
Number of pages	12
Journal	Epilepsia
Volume	60
Issue number	12
DOIs	https://doi.org/10.1111/epi.16378
State	Published - Dec 1 2019

Bibliographical note

Funding Information:
R.A.M., A.N.V.M., R.B., L.F., E.W., and W.E.B. have no conflict of interest to disclose. L.J. is funded by National Institutes of Health grant R01 NS097719, and has received research funding from Eisai. A.G. serves on the advisory board for Eisai and the editorial board of Pediatric Neurology . He is also a consultant for Mallinckrodt and has received a research grant from the Tuberous Sclerosis Alliance. J.G.‐M. serves as a consultant for Zimmer Biomet. I.N. has received funding from the National Institute of Neurological Disorders and Stroke, and serves on the advisory board for Eisai. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Publisher Copyright:
Wiley Periodicals, Inc. © 2019 International League Against Epilepsy

Keywords

epilepsy surgery
hemispherectomy in adults
outcomes
refractory epilepsy

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10.1111/epi.16378

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title = "Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients",

abstract = "Objective: To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents. Methods: We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed. Results: Thirty-six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow-up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6-month follow-up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes. Significance: Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.",

keywords = "epilepsy surgery, hemispherectomy in adults, outcomes, refractory epilepsy",

author = "McGovern, {Robert A.} and {N. V. Moosa}, Ahsan and Lara Jehi and Robyn Busch and Lisa Ferguson and Ajay Gupta and Jorge Gonzalez-Martinez and Elaine Wyllie and Imad Najm and Bingaman, {William E.}",

note = "Funding Information: R.A.M., A.N.V.M., R.B., L.F., E.W., and W.E.B. have no conflict of interest to disclose. L.J. is funded by National Institutes of Health grant R01 NS097719, and has received research funding from Eisai. A.G. serves on the advisory board for Eisai and the editorial board of Pediatric Neurology . He is also a consultant for Mallinckrodt and has received a research grant from the Tuberous Sclerosis Alliance. J.G.‐M. serves as a consultant for Zimmer Biomet. I.N. has received funding from the National Institute of Neurological Disorders and Stroke, and serves on the advisory board for Eisai. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Publisher Copyright: Wiley Periodicals, Inc. {\textcopyright} 2019 International League Against Epilepsy",

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AU - McGovern, Robert A.

AU - N. V. Moosa, Ahsan

AU - Jehi, Lara

AU - Busch, Robyn

AU - Ferguson, Lisa

AU - Gupta, Ajay

AU - Gonzalez-Martinez, Jorge

AU - Wyllie, Elaine

AU - Najm, Imad

AU - Bingaman, William E.

N1 - Funding Information: R.A.M., A.N.V.M., R.B., L.F., E.W., and W.E.B. have no conflict of interest to disclose. L.J. is funded by National Institutes of Health grant R01 NS097719, and has received research funding from Eisai. A.G. serves on the advisory board for Eisai and the editorial board of Pediatric Neurology . He is also a consultant for Mallinckrodt and has received a research grant from the Tuberous Sclerosis Alliance. J.G.‐M. serves as a consultant for Zimmer Biomet. I.N. has received funding from the National Institute of Neurological Disorders and Stroke, and serves on the advisory board for Eisai. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Publisher Copyright: Wiley Periodicals, Inc. © 2019 International League Against Epilepsy

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Objective: To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents. Methods: We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed. Results: Thirty-six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow-up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6-month follow-up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes. Significance: Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.

AB - Objective: To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents. Methods: We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed. Results: Thirty-six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow-up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6-month follow-up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes. Significance: Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.

KW - epilepsy surgery

KW - hemispherectomy in adults

KW - outcomes

KW - refractory epilepsy

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Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients

Abstract

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