Epilepsy surgery for Rasmussen encephalitis: the UCLA experience

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  • 1 Departments of Neurosurgery,
  • 2 Pediatrics, and
  • 3 Psychiatry and Biobehavioral Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California;
  • 4 Department of Neuroscience, Brown University, Providence, Rhode Island; and
  • 5 Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
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OBJECTIVE

Rasmussen encephalitis (RE) is a rare inflammatory neurological disorder typically involving one hemisphere and resulting in drug-resistant epilepsy and progressive neurological decline. Here, the authors present seizure outcomes in children who underwent epilepsy surgery for RE at a single institution.

METHODS

The records of consecutive patients who had undergone epilepsy surgery for RE at the UCLA Mattel Children’s Hospital between 1982 and 2018 were retrospectively reviewed. Basic demographic information, seizure history, procedural notes, and postoperative seizure and functional outcome data were analyzed.

RESULTS

The cohort included 44 patients, 41 of whom had sufficient data for analysis. Seizure freedom was achieved in 68%, 48%, and 22% of the patients at 1, 5, and 10 years, respectively. The median time to the first seizure for those who experienced seizure recurrence after surgery was 39 weeks (IQR 11–355 weeks). Anatomical hemispherectomy, as compared to functional hemispherectomy, was independently associated with a longer time to postoperative seizure recurrence (HR 0.078, p = 0.03). There was no statistically significant difference in postoperative seizure recurrence between patients with complete hemispherectomy and those who had less-than-hemispheric surgery. Following surgery, 68% of the patients could ambulate and 84% could speak regardless of operative intervention.

CONCLUSIONS

A large proportion of RE patients will have seizure relapse after surgery, though patients with anatomical hemispherectomies may have a longer time to postoperative seizure recurrence. Overall, the long-term data in this study suggest that hemispheric surgery can be seen as palliative treatment for seizures rather than a cure for RE.

ABBREVIATIONS CN = cranial nerve; EPC = epilepsia partialis continua; RE = Rasmussen encephalitis.

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Contributor Notes

Correspondence Aria Fallah: David Geffen School of Medicine at UCLA, Los Angeles, CA. afallah@mednet.ucla.edu.

INCLUDE WHEN CITING Published online July 17, 2020; DOI: 10.3171/2020.4.PEDS2098.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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