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. 2012:2012:527891.
doi: 10.1155/2012/527891. Epub 2012 Feb 9.

Outcomes of disconnective surgery in intractable pediatric hemispheric and subhemispheric epilepsy

Santhosh George Thomas  1 , Ari George Chacko, Maya Mary Thomas, K Srinivasa Babu, Paul Swamidhas Sudhakar Russell, Roy Thomas Daniel
Affiliations

Outcomes of disconnective surgery in intractable pediatric hemispheric and subhemispheric epilepsy

Santhosh George Thomas et al. Int J Pediatr. 2012.

Abstract

Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy.

Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel's classification and cognitive skills by appropriate measures of intelligence that were repeated annually.

Results: There were 34 patients in all. Epilepsy was due to Rasmussen's encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome.

Conclusions: There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome.

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Figures

Figure 1
Figure 1
Intraoperative photograph of peri-insular hemispherotomy (PIH) showing the supra- and infrainsular windows.
Figure 2
Figure 2
Intraoperative photograph of peri-insular posterior quadrantectomy (PIPQ) showing the line of disconnection.
Figure 3
Figure 3
T2W Axial flair MRI images of a patient with Rasmussen's encephlitis taken six months apart showing progression of disease.
Figure 4
Figure 4
T2W Axial flair MRI image of a 3-year-old boy with infantile hemiplegia seizure syndrome (IHSS).
Figure 5
Figure 5
(a) T2W Axial Flair MRI Image of a patient with right hemimegalencephaly showing an enlarged right hemisphere with thickened cortical mantle, distorted ventricular anatomy, and widened gyri, (b) intraoperative photograph.
Figure 6
Figure 6
(a) T1W Axial gadolinium MRI image of a patient with Sturge Weber disease showing left hemispheric leptomeningeal angiomatosis, (b) intraoperative photograph.
Figure 7
Figure 7
T2W Axial MRI image of a 5-year-old boy who presented with intractable epilepsy secondary to postencephalitic sequelae (PES) causing damage to the right side.
See this image and copyright information in PMC

References

    1. Robert HAH. Seizures in childhood. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 16th edition. WB Saunders; 2000. pp. 1813–1825.
    1. Radhakrishnan K, Pandian JD, Santhoshkumar T, et al. Prevalence, knowledge, attitude and practice of epilepsy in Kerala, South India. Epilepsia. 2000;41(8):1027–1035. - PubMed
    1. Cross JH. Epilepsy surgery in childhood. Epilepsia. 2002;43(3):65–70. - PubMed
    1. Daniel RT, Thomas SG, Thomas M. Role of surgery in pediatric epilepsy. Indian Pediatrics. 2007;44(4):263–273. - PubMed
    1. Janszky J, Rásonyi G, Fogarasi A, et al. Surgically treatable epilepsy—a review. Orvosi Hetilap. 2001;142(30):1597–1604. - PubMed

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