Hemispherectomy in adults patients with severe unilateral epilepsy and hemiplegia

Abstract

Objectives: To study postoperative seizure control of hemispherectomy in adults with epilepsy and evaluate changes of movement and speech function, intelligence quotient (IQ) and quality of life (QOL) after hemispherectomy.

Methods: We retrospectively analyzed 25 adults who presented severe unilateral epilepsy and hemiplegia and underwent anatomic or functional hemispherectomy in between 2006 and 2011. Surgical outcomes, including seizure-control at last follow-up, changes of aphasia quotient, hemiplegic side motor function, IQ and QOL from pre-operative to 2 years follow-up, were investigated. Results were statistically analyzed with SPSS 18.0.

Results: Nine functional hemispherectomies and 16 anatomic hemispherectomies were performed. Ninety-two percent of patients were seizure-free and 8% displayed Engel II grade seizure control after the procedure. Impaired movement function was present in 9 (36%) adults' upper limbs and 5 (20%) patients' lower limbs. The patients with age at seizure onset <3 years showed improvement in mean motor function of the upper limbs. Impaired speech was seen in 7 patients with left hemispherectomies. There was an overall improvement in the mean aphasia quotient and significant difference was found in amount of change in aphasia quotients between patients with different ages of onset. All of the patients' postoperative scores of overall QOL, full IQ, verbal IQ and performance IQ improved compared with pretreatment scores and those improvements were not associated with patient's age at seizure onset or surgical approach. However, significant difference was found in change of verbal IQ between patients with right hemispherectomies and those with left hemispherectomies. Surgical complications included a single case of hydrocephalus, and 6 transient complications.

Conclusions: Hemispherectomy presented good seizure control and improvement in QOL and IQ, and impairment on motor and speech function were mild. Furthermore, patients with early seizure onset could maintain movement function of upper limb and speech function improvement. Therefore, it is worth pursuing hemispherectomy in well-selected adults with severe unilateral epilepsy and hemiplegia.

Keywords: Adult; Epilepsy; Hemiplegia; Hemispherectomy.