The Cognitive Outcome of Hemispherectomy in 71 Children

Purpose: Long‐term neuropsychological outcome was studied in 71 patients who underwent hemispherectomy for severe and intractable seizures at The Johns Hopkins Hospital between 1968 and 1997 and who agreed to participate. Seizures were due to cortical dysplasias (n = 27), Rasmussen syndrome (n = 37)...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2004-03, Vol.45 (3), p.243-254
Main Authors: Pulsifer, Margaret B., Brandt, Jason, Salorio, Cynthia F., Vining, Eileen P. G., Carson, Benjamin S., Freeman, John M.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Child
Cognition Disorders - diagnosis
Cognition Disorders - etiology
Cross-Sectional Studies
Epilepsy - diagnosis
Epilepsy - surgery
Female
Follow-Up Studies
Functional Laterality
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Hemispherectomy
Humans
Male
Medical sciences
Nervous system (semeiology, syndromes)
Neurology
Neuropsychological Tests
Neuropsychology
Severity of Illness Index
Treatment Outcome
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Summary:Purpose: Long‐term neuropsychological outcome was studied in 71 patients who underwent hemispherectomy for severe and intractable seizures at The Johns Hopkins Hospital between 1968 and 1997 and who agreed to participate. Seizures were due to cortical dysplasias (n = 27), Rasmussen syndrome (n = 37), or vascular malformations or strokes (n = 7). Both presurgical and follow‐up results are available and reported for 53 patients. Methods: Patients and caretakers were interviewed, and patients were administered standard measures of intelligence, receptive and expressive language, visual‐motor skills, adaptive/developmental functioning, and behavior. Results: Mean age at surgery was 7.2 years. At follow‐up, on average 5.4 years after surgery, 65% are seizure free, 49% are medication free, and, of those responding, none rated quality of life as worse than before surgery. Mean IQ was in the 70s for Rasmussen and vascular patients and in the 30s for cortical dysplasia patients. Language and visual‐motor skills were consistent with IQ. For Rasmussen patients only, language was significantly more impaired for left than for right hemispherectomy, both before surgery and at follow‐up. Adaptive skills were mildly impaired, with greatest impairment in the physical domain. Cognitive measures typically changed little between surgery and follow‐up, with IQ change
ISSN:0013-9580
1528-1167
DOI:10.1111/j.0013-9580.2004.15303.x