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Hemispherectomy in pediatric patients with epilepsy: a study of 45 cases with special emphasis on epileptic syndromes

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Abstract

Objective

In this study we report the clinical outcomes of hemispherectomy for epilepsy in pediatric patients with special emphasis on the epileptic syndromes and their etiologies.

Material and methods

We retrospectively studied 45 patients with medically refractory epilepsy with hemispheric lesions who underwent hemispherectomy at the “Hospital de Pediatría Prof. Dr. Juan P. Garrahan”, Buenos Aires, Argentina between February 1990 and February 2010. Patients had been assessed using a standard protocol involving clinical, neuroradiological, neurophysiological, and neuropsychological teams.

Results

Twenty-seven males and 18 females with a mean age of 8.5 years (range, 2 months to 18 years) who underwent epilepsy surgery for refractory epilepsy were assessed. The mean time of follow-up was 9.5 years (range, 1 to 16 years). The following epileptic syndromes were recognized: West syndrome in 15 patients (33.5%), Rasmussen syndrome in 13 (29%), focal symptomatic epilepsy in 8 (17.5%), startle epilepsy in 6 (13.5%), Lennox–Gastaut syndrome in 2 (5%), and continuous spikes and waves during slow sleep in 1 (2%). The surgical specimens revealed malformations of cortical development in 18 patients (40%), Rasmussen encephalitis in 13 (29%), porencephalic lesions in 10 (22%), gliosis in 2 (4.4%), tumor in 1 (2.2%), and Sturge–Weber syndrome in 1 (2.2%).

Conclusion

The outcome of hemispherectomy in pediatric patients is good for those with refractory epilepsies, such as West syndrome, Lennox–Gastaut syndrome, epileptic encephalopathy with continuous spikes and waves during slow sleep, and startle epilepsy arising from a hemispheric lesion associated with hemiplegia.

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Acknowledgments

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.

Disclosure of conflicts of interest

None of the authors has any conflicts of interest.

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Authors and Affiliations

  1. Neurology Department, Hospital Nacional de Pediatría “Prof Dr Juan P Garrahan”, Combate de los Pozos 1881, CP 1245, Buenos Aires, Argentina

    Roberto Caraballo, Ricardo Cersósimo & Alejandra Soraru

  2. Neurosurgery Department, Hospital Nacional de Pediatría “Prof Dr Juan P Garrahan”, Combate de los Pozos 1881, Buenos Aires, Argentina

    Marcelo Bartuluchi & Hugo Pomata

Authors
  1. Roberto Caraballo
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  2. Marcelo Bartuluchi
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  3. Ricardo Cersósimo
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  4. Alejandra Soraru
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  5. Hugo Pomata
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Corresponding author

Correspondence to Roberto Caraballo.

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Caraballo, R., Bartuluchi, M., Cersósimo, R. et al. Hemispherectomy in pediatric patients with epilepsy: a study of 45 cases with special emphasis on epileptic syndromes. Childs Nerv Syst 27, 2131–2136 (2011). https://doi.org/10.1007/s00381-011-1596-5

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  • DOI: https://doi.org/10.1007/s00381-011-1596-5

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