- 作者：Ana Paula Hamad ; Lu¨ªs Ot¨¢vio Caboclo ; Ricardo Centeno ; Livia Vianez Costa ; Carol Ladeia-Frota ; Henrique Carrete Junior ; Nicolas Garofalo Gomez ; Murilo Marinho ; Elza M¨¢rcia Targas Yacubian ; Am¨¦rico Ceiki Sakamoto
- 关键词：Epilepsy ; Children ; Hemispheric surgery ; Motor function ; Outcome ; Follow-up ; Impairment
- 刊名：Seizure
- 出版年：2013
- 出版时间：November, 2013
- 年：2013
- 卷：22
- 期：9
- 页码：752-756
- 全文大小：558 K
Purpose
The aim of the study was to report the seizure outcome, motor skills and adaptive motor functions in a series of children and adolescents who underwent hemispheric surgery, analysing the risk-benefits of surgery.Methods
The clinical course, seizure and motor function outcomes of 15 patients who underwent hemispheric surgery were reviewed.
Results
The mean age at surgery was 9.5, with 1-9 years follow-up. The underlying pathologies were Rasmussen encephalitis, vascular disorders, and hemimegalencephaly. All the patients presented with severe epilepsy and different degrees of hemiparesis, although motor functionality was preserved in 80 % of the patients. At last follow-up, 67 % were seizure free, and 20 % rarely experienced seizures. Antiepileptic drugs were reduced in 60 % , and complete withdrawal from such drugs was successful in 20 % of the patients. The motor outcome following the surgery varied between the patients.
Despite the motor deficit after surgery, the post-operative motor function showed unchanged for gross motor function in most (60 % ), while 27 % improved. Similar results were obtained for the ability to handle objects in daily life activities. Sixty percent of the children were capable of handling objects, with somewhat reduced coordination and/or motor speed.
Conclusion
Pre-surgical motor function continues to play a role in the pre-surgical evaluation process in order to provide a baseline for outcome. Hemispheric surgery, once regarded as a radical intervention and last treatment resource, may become routinely indicated for refractory hemispheric epilepsy in children and adolescents, with oftentime favourable motor outcomes.