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Randomized Controlled Trial
. 2021 Nov;62(11):2707-2718.
doi: 10.1111/epi.17021. Epub 2021 Sep 12.

Comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug-resistant epilepsy: A post hoc analysis of the HOPS study

Aria Fallah  1 , Evan Lewis  2 , George M Ibrahim  3 , Olivia Kola  1 , Chi-Hong Tseng  4 , William B Harris  5 , Jia-Shu Chen  6 , Kao-Min Lin  7 , Li-Xin Cai  8 , Qing-Zhu Liu  8 , Jiu-Luan Lin  9 , Wen-Jing Zhou  9 , Gary W Mathern  1 , Matthew D Smyth  10 , Brent R O'Neill  11 , Roy W R Dudley  12 , John Ragheb  13 , Sanjiv Bhatia  13 , Daniel Delev  14 , Georgia Ramantani  14   15 , Josef Zentner  14 , Anthony C Wang  1 , Christian Dorfer  16 , Martha Feucht  17 , Thomas Czech  16 , Robert J Bollo  18 , Galymzhan Issabekov  19 , Hongwei Zhu  19 , Mary Connolly  20 , Paul Steinbok  20 , Jian-Guo Zhang  21 , Kai Zhang  21 , Eveline Teresa Hidalgo  22 , Howard L Weiner  23 , Lily Wong-Kisiel  24 , Samuel Lapalme-Remis  25 , Manjari Tripathi  26 , Poodipedi Sarat Chandra  27 , Walter Hader  28 , Feng-Peng Wang  7 , Yi Yao  29 , Pierre-Olivier Champagne  30 , Tristan Brunette-Clément  30 , Qiang Guo  31 , Shao-Chun Li  31 , Marcelo Budke  32 , Maria Angeles Pérez-Jiménez  33 , Christian Raftopoulos  34 , Patrice Finet  34 , Pauline Michel  34 , Karl Schaller  35 , Martin N Stienen  36 , Valentina Baro  37 , Christian Cantillano Malone  38 , Juan Pociecha  39 , Noelia Chamorro  39 , Valeria L Muro  39 , Marec von Lehe  40 , Silvia Vieker  40 , Chima Oluigbo  41 , William D Gaillard  42 , Mashael Al-Khateeb  43 , Faisal Al Otaibi  43 , Niklaus Krayenbühl  36 , Jeffrey Bolton  44 , Phillip L Pearl  44 , Alexander G Weil  30
Affiliations
Randomized Controlled Trial

Comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug-resistant epilepsy: A post hoc analysis of the HOPS study

Aria Fallah et al. Epilepsia. 2021 Nov.

Abstract

Objective: This study was undertaken to determine whether the vertical parasagittal approach or the lateral peri-insular/peri-Sylvian approach to hemispheric surgery is the superior technique in achieving long-term seizure freedom.

Methods: We conducted a post hoc subgroup analysis of the HOPS (Hemispheric Surgery Outcome Prediction Scale) study, an international, multicenter, retrospective cohort study that identified predictors of seizure freedom through logistic regression modeling. Only patients undergoing vertical parasagittal, lateral peri-insular/peri-Sylvian, or lateral trans-Sylvian hemispherotomy were included in this post hoc analysis. Differences in seizure freedom rates were assessed using a time-to-event method and calculated using the Kaplan-Meier survival method.

Results: Data for 672 participants across 23 centers were collected on the specific hemispherotomy approach. Of these, 72 (10.7%) underwent vertical parasagittal hemispherotomy and 600 (89.3%) underwent lateral peri-insular/peri-Sylvian or trans-Sylvian hemispherotomy. Seizure freedom was obtained in 62.4% (95% confidence interval [CI] = 53.5%-70.2%) of the entire cohort at 10-year follow-up. Seizure freedom was 88.8% (95% CI = 78.9%-94.3%) at 1-year follow-up and persisted at 85.5% (95% CI = 74.7%-92.0%) across 5- and 10-year follow-up in the vertical subgroup. In contrast, seizure freedom decreased from 89.2% (95% CI = 86.3%-91.5%) at 1-year to 72.1% (95% CI = 66.9%-76.7%) at 5-year to 57.2% (95% CI = 46.6%-66.4%) at 10-year follow-up for the lateral subgroup. Log-rank test found that vertical hemispherotomy was associated with durable seizure-free progression compared to the lateral approach (p = .01). Patients undergoing the lateral hemispherotomy technique had a shorter time-to-seizure recurrence (hazard ratio = 2.56, 95% CI = 1.08-6.04, p = .03) and increased seizure recurrence odds (odds ratio = 3.67, 95% CI = 1.05-12.86, p = .04) compared to those undergoing the vertical hemispherotomy technique.

Significance: This pilot study demonstrated more durable seizure freedom of the vertical technique compared to lateral hemispherotomy techniques. Further studies, such as prospective expertise-based observational studies or a randomized clinical trial, are required to determine whether a vertical approach to hemispheric surgery provides superior long-term seizure outcomes.

Keywords: hemispherectomy; hemispherotomy; seizure outcomes; technique.

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Conflict of interest statement

G.W.M. is partly supported by the Davies/Crandall Endowed Chair for epilepsy research at University of California, Los Angeles. The views expressed in this article are not the official positions of any author's affiliated institution. P.L.P. has received research support from the National Institutes of Health (NIH), National Science Foundation (NSF), and Boston Healthcare Associates; has received royalty payments from Elsevier, Springer Publishing, and UpToDate; has served as a consultant for Agilis Biotherapeutics and GLG Health Care Council; and is an associate editor for the Journal of Child Neurology and on the editorial boards of Annals of Neurology, Epilepsia, Future Neurology, Music and Medicine, and Neurology. None of the other authors has any conflict of interest to disclose. 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.

Figures

FIGURE 1
FIGURE 1
Illustration demonstrating hemispherotomy techniques. (A) Vertical parasagittal. (B) Lateral peri‐insular/peri‐Sylvian. (C) Lateral trans‐Sylvian
FIGURE 2
FIGURE 2
Kaplan–Meier curve depicting the seizure freedom function for the entire cohort of children undergoing lateral or vertical hemispherotomy for medically intractable epilepsy
FIGURE 3
FIGURE 3
Comparison of Kaplan–Meier curves depicting the seizure freedom functions of vertical and lateral hemispherotomy cohorts
See this image and copyright information in PMC

Comment in

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