Periinsular hemispherotomy in children with stroke-induced refractory epilepsy

Clinical article

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  • 1 Department of Pediatric Neurosurgery, Hôpital des Enfants La Timone, Marseille, France; and
  • | 2 Departments of Pediatric Neurology and
  • | 3 Pediatric Neurosurgery, Centre Hospitalier Universitaire, Sainte-Justine, Montreal, Quebec, Canada
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Object

Ischemic cerebral vascular accidents (CVAs) in children result in epilepsy in 25% of patients, which is refractory in 7% of cases. Repeated seizures worsen the global and cognitive prognosis of these patients. To evaluate the prognosis of epilepsy and cognitive development in children with refractory seizures following a CVA, the authors retrospectively studied the effectiveness of periinsular hemispherotomy in the treatment of these patients.

Methods

Between March 1995 and November 2007, 8 children who suffered from stroke-induced refractory epilepsy underwent a periinsular hemispherotomy. All patients' charts were reviewed in a retrospective manner. Age at the time of the CVA, imaging studies, cause of the ischemic event, onset of the first seizure, patient's handedness, the extent of the parenchymal damage, electroencephalography findings, type of epileptic seizures, number of seizures per day, number of antiepileptic medications, preoperative neuropsychological evaluation, and surgical outcome with regard to the patient's seizure activity were analyzed.

Results

There were 7 boys and 1 girl in this study. The mean age at stroke was 23 months (range birth–5 years). The mean age at onset of epilepsy was 22 months (range 0–60 months). The mean age at the time of the hemispherotomy was 7 years (range 54–130 months). The average delay prior to the hemispherotomy was 5 years and 3 months (range 23–115 months). Prior to surgery, the average number of seizures per day was 35 (range 5–100). The average number of antiepileptic medications introduced before the hemispherotomy was 8 (range 6–12). Six patients required only 1 surgical intervention and 2 necessitated 2 separate operations:1 underwent a 2-staged hemispherotomy and the other underwent a prior callosotomy. There were no reported surgical complications in this series. Seven children are seizure free. However, the remaining child, after a 3.5-year disease-free interval, has recently started having seizures. No child demonstrated an improvement in neuropsychological evaluation.

Conclusions

The periinsular hemispherotomy must be considered an alternative in the therapeutic approach to stroke-induced pediatric refractory epilepsy. It is effective in controlling seizure activity. The authors believe the delay before hemispherotomy must be shortened in children with post-CVA refractory epilepsy.

Abbreviations used in this paper:

AED = antiepileptic drug; CVA = cerebrovascular accident; EEG = electroencephalography; MCA = middle cerebral artery.

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  • 1

    Basheer SN, , Connolly MB, , Lautzenhiser A, , Sherman EM, , Hendson G, & Steinbok P: Hemispheric surgery in children with refractory epilepsy: seizure outcome, complications, and adaptive function. Epilepsia 48:133140, 2007

    • Search Google Scholar
    • Export Citation
  • 2

    Beardsworth ED, & Adams CB: Modified hemispherectomy for epilepsy: early results in 10 cases. Br J Neurosurg 2:7384, 1988

  • 3

    Cook SW, , Nguyen ST, , Hu B, , Yudovin S, , Shields WD, & Vinters HV, et al.: Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. J Neurosurg 100:125141, 2004

    • Search Google Scholar
    • Export Citation
  • 4

    Daniel RT, & Villemure JG: Hemispherotomy techniques. J Neurosurg 98:438439, 2003

  • 5

    de Almeida AN, , Marino R Jr, , Marie SK, , Aguiar PH, & Teixeira MJ: Factors of morbidity in hemispherectomies: surgical technique x pathology. Brain Dev 28:215222, 2006

    • Search Google Scholar
    • Export Citation
  • 6

    De Carolis P, , D'Alessandro R, , Ferrara R, , Andreoli A, , Sacquegna T, & Lugaresi E: Late seizures in patients with internal carotid and middle cerebral artery occlusive disease following ischaemic events. J Neurol Neurosurg Psychiatry 47:13451347, 1984

    • Search Google Scholar
    • Export Citation
  • 7

    De Reuck J, , De Groote L, & Van Maele G: Single seizure and epilepsy in patients with a cerebral territorial infarct. J Neurol Sci 271:127130, 2008

    • Search Google Scholar
    • Export Citation
  • 8

    De Schryver EL, , Kappelle LJ, , Jennekens-Schinkel A, & Boudewyn Peters AC: Prognosis of ischemic stroke in childhood: a long-term follow-up study. Dev Med Child Neurol 42:313318, 2000

    • Search Google Scholar
    • Export Citation
  • 9

    Delalande O, , Bulteau C, , Dellatolas G, , Fohlen M, , Jalin C, & Buret V, et al.: Vertical parasagittal hemispherectomy: surgical procedures and clinical long-term outcomes in a population of 83 children. Neurosurgery 60:1932, 2007

    • Search Google Scholar
    • Export Citation
  • 10

    Delalande O, , Fohlen M, , Bulteau C, & Jalin C: [Surgery for intractable focal epilepsy in children]. Rev Neurol (Paris) 160:195202, 2004. (Fr)

    • Search Google Scholar
    • Export Citation
  • 11

    deVeber GA, , MacGregor D, , Curtis R, & Mayank S: Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 15:316324, 2000

    • Search Google Scholar
    • Export Citation
  • 12

    Devlin AM, , Cross JH, , Harkness W, , Chong WK, , Harding B, & Vargha-Khadem F, et al.: Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain 126:556566, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Di Rocco C, , Battaglia D, , Pietrini D, , Piastra M, & Massimi L: Hemimegalencephaly: clinical implications and surgical treatment. Childs Nerv Syst 22:852866, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Engel J Jr, , Van Ness PC, , Rasmussen TB, & Ojemann LM, Outcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies ed 2 New York, Raven Press, 1993. 609621

    • Search Google Scholar
    • Export Citation
  • 15

    Ganesan V, , Hogan A, , Shack N, , Gordon A, , Isaacs E, & Kirkham FJ: Outcome after ischaemic stroke in childhood. Dev Med Child Neurol 42:455461, 2000

    • Search Google Scholar
    • Export Citation
  • 16

    Giroud M, , Lemesle M, , Madinier G, , Manceau E, , Osseby GV, & Dumas R: Stroke in children under 16 years of age. Clinical and etiological difference with adults. Acta Neurol Scand 96:401406, 1997

    • Search Google Scholar
    • Export Citation
  • 17

    Guenot M: [Surgical treatment of epilepsy: outcome of various surgical procedures in adults and children.]. Rev Neurol (Paris) 160:241250, 2004. (Fr)

    • Search Google Scholar
    • Export Citation
  • 18

    Hauser WA, , Raminez-Lassepas M, & Rosenstein R: Risk for seizures and epilepsy following cerebrovascular insults. Epilepsia 25:666, 1984. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 19

    Jonas R, , Nguyen S, , Hu B, , Asarnow RF, , LoPresti C, & Curtiss S, et al.: Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology 62:17121721, 2004

    • Search Google Scholar
    • Export Citation
  • 20

    Kestle J, , Connolly M, & Cochrane D: Pediatric peri-insular hemispherotomy. Pediatr Neurosurg 32:4447, 2000

  • 21

    Lassonde M, , Sauerwein HC, , Jambaque I, , Smith ML, & Helmstaedter C: Neuropsychology of childhood epilepsy: pre- and postsurgical assessment. Epileptic Disord 2:313, 2000

    • Search Google Scholar
    • Export Citation
  • 22

    Martinez-Manas R, , Daniel RT, , Debatisse D, , Maeder-Ingvar M, , Meagher-Villemure K, & Villemure JG, et al.: Intractable reflex audiogenic epilepsy successfully treated by peri-insular hemispherotomy. Seizure 13:486490, 2004

    • Search Google Scholar
    • Export Citation
  • 23

    Morino M, , Shimizu H, , Ishibashi K, , Sakamoto S, , Tsuyuguchi N, & Ohata K, et al.: Effectiveness of cerebral hemispherotomy for improving behavioral disorders associated with intractable post-traumatic seizures. Neurol Med Chir (Tokyo) 46:182185, 2006

    • Search Google Scholar
    • Export Citation
  • 24

    Morino M, , Shimizu H, , Uda T, , Naitoh K, , Kawahara S, & Ishiguro T, et al.: Transventricular hemispherotomy for surgical treatment of intractable epilepsy. J Clin Neurosci 14:171175, 2007

    • Search Google Scholar
    • Export Citation
  • 25

    Pollo C, , Debatisse D, , Pralong E, & Levivier M: [Periinsular hemispherotomy: surgical technique, intraoperative EEG monitoring and results on seizure outcome.]. Neurochirurgie 54:303310, 2008. (Fr)

    • Search Google Scholar
    • Export Citation
  • 26

    Pulsifer MB, , Brandt J, , Salorio CF, , Vining EP, , Carson BS, & Freeman JM: The cognitive outcome of hemispherectomy in 71 children. Epilepsia 45:243254, 2004

    • Search Google Scholar
    • Export Citation
  • 27

    Rasmussen T: Hemispherectomy for seizures revisited. Can J Neurol Sci 10:7178, 1983

  • 28

    Schropp C, , Sorensen N, & Krauss J: Early periinsular hemispherotomy in children with Sturge-Weber syndrome and intractable epilepsy–outcome in eight patients. Neuropediatrics 37:2631, 2006

    • Search Google Scholar
    • Export Citation
  • 29

    Smith JR, , Fountas KN, & Lee MR: Hemispherotomy: description of surgical technique. Childs Nerv Syst 21:466472, 2005

  • 30

    Steinlin M, , Roellin K, & Schroth G: Long-term follow-up after stroke in childhood. Eur J Pediatr 163:245250, 2004

  • 31

    van Empelen R, , Jennekens-Schinkel A, , Buskens E, , Helders PJ, & van Nieuwenhuizen O: Functional consequences of hemispherectomy. Brain 127:20712079, 2004

    • Search Google Scholar
    • Export Citation
  • 32

    Vargha-Khadem F, , Isaacs E, & Muter V: A review of cognitive outcome after unilateral lesions sustained during childhood. J Child Neurol 9:2 Suppl 6773, 1994

    • Search Google Scholar
    • Export Citation
  • 33

    Villemure JG: [Surgery of epilepsy in children: who, when, how, and why.]. Rev Med Suisse Romande 123:577581, 2003. (Fr)

  • 34

    Villemure JG, & Daniel RT: Peri-insular hemispherotomy in paediatric epilepsy. Childs Nerv Syst 22:967981, 2006

  • 35

    Villemure JG, & Mascott CR: Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 37:975981, 1995

  • 36

    Yang JS, , Park YD, & Hartlage PL: Seizures associated with stroke in childhood. Pediatr Neurol 12:136138, 1995

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