Therapeutic effect of functional hemispherectomy on intractable epilepsy with hemiparalysis
10.3760/cma.j.issn.1671-8925.2009.08.023
- VernacularTitle:功能性大脑半球切除术治疗顽固性癫痫
- Author:
Qi-Fu TAN
1
;
Xin-Wei ZHANG
;
Yi YAO
;
Jia-Tang WANG
Author Information
1. 南京军区南京总医院
- Keywords:
Functional hemispherectomy;
Eiplepsy;
Hemiparalysis
- From:
Chinese Journal of Neuromedicine
2009;8(8):844-847
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effect of functional hemispherectomy on intractable epilepsy with hemiparalysis. Methods From April 2002 to December 2007, 8 epileptic patients with hemisphere atrophy received functional hemispherectomy in 6 hospitals. Scalp and video EEG examinations revealed epileptic waves in all the patients, including 7 in the ipsilateral side and 1 in the contralateral side. Magnetic resonance imaging (MRI) indicated hemisphere atrophy and ventriculomegaly in all the patients. Risk factors for epilepsy were found in all the patients, including 3 with hyperpyrexia, 2 with spontaneous intracranial hemorrhage, 2 with traumatic brain injury, and 1 with viral encephalitis (also suspected of Rasmussen's encephalitis). Hemispberectomy was performed based on the methods of Rasmussen and Schramm. Results All the patients were followed up postoperatively for 8 months to 6.4 years (mean 2.8 years). Satisfactory outcomes (including disappearance of seizures) were achieved in 6 patients, but 1 of them experienced seizure reoccurrence because of personal withdraw of antiepileptic drugs 2 years after total seizure relief, and was successfully managed by administration of another two antiepileptic drugs. Significant improvement was achieved in the other case, in which the seizure frequency was reduced by over 70%. The postoperative dose or number of the antiepileptic drugs was reduced in 6 patients, and 2 patients no longer required any medication. No death or serious complications occurred in these patients except for 1 patient who suffered acute status epilepticns perioperatively and was successfully managed. Postoperative EEG revealed the absence of epileptic waves in 6 patients. Two patients showed epileptic waves on the contralateral side. Paralysis aggravation was not observed in 7 patients, and 1 patient experienced temporal muscle weakness, which recovered gradually. Six patients showed improved limb functions, but the thumb function failed to recover. The patients became gentle and cooperative after the operation, and 4 were able to receive formal education. Two patients were capable of carrying out housework, and 2 stayed at home. Conclusion Functional hemispherectomy is effective for management of intractable epilepsy with paralysis and causes low rate of complications.
