The Cognitive Outcome of Hemispherectomy in 71 Children
This paper analyzed the cognitive outcomes of 71 children who underwent either anatomic hemispherectomy or hemidecordication between the years 1968-1997. 4 of theses children had passed away by follow-up in 1996-1998. 2 were unable to be located, and another 2 were unwilling to undergo reevaluation. The remaining 71 patients gave informed consent to participate in reevalutation. Cognitive tests were given to the patients prior to surgery and after. These tests were administered under the assumption of performance scores based on the chronologic age of the patients. Tests included general intelligence, mental/adaptive skills, behavior, and 3 tests focused specifically on testing right and left hemisphere function, such as visual and language testing. The three neurologic conditions- Rasmussen Encephalopathy, Cortical Dysplasia, and Vascular Etiology- all had different post-surgical outcomes. The rates of being seizure free after surgery are 73%, 44%, and 100% respectively. The age of onset of seizures is proposed to be the main proponent in this finding(Cortical Dysplasia being the earliest age of seizure activity with most children exhibiting symptoms prior to 12 months of age).
Citation:
Pulsifer, Margaret B., Brandt, Jason, Salorio, Cynthia F., Vining, Eileen P.G., Carson, Benjamin S., and Freeman, John M. The Cognitive Outcome of Hemispherectomy in 71 Children. Epiplesia 45: 243-254.
Language Recovery after Left Hemispherectomy
This article analyzed the recovery of a patient’s language skills after a left hemispherectomy. For background, the left frontal lobe of the brain- a part of the left hemisphere- is responsible for many of the cognitive aspects of a human’s language skills. This study specifically dealt with 6 children, 3 of which were male and 3 of which were female, all right handed, and all diagnosed with Rasmussen’s syndrome. Each underwent a left hemidecorticectomy, and according to parents, each of the children expressed age appropriate language skills, both receptive and expressive. Tests included phoneme discrimination, picture-word matching, and the Wechsler Intelligence Scale for children. Other tests included naming of pictures, repetition of words, and the peabody picture vocabulary test. Certain tests showed language impairment or lacking behind the control such as phoneme discrimination, expressive language testing, and the picture word matching task. Patient word repetition scores did not differ from the control groups. Despite language decline in many of the children, quality of life improved drastically and all patients were seizure free after surgery.
Citation:
Boatman, Dana, Freeman, John, Vining, Eileen, Pulsifer, Margaret, Miglioretti, Diana, Minahan, Robert, Carson, Benjamin, Brandt, Jason, and McKhann, Guy 1999. Language Recovery after Left Hemispherectomy in Children with Late-Onset Seizures. American Neurological Association 46: 579-586.
Locomotive Recovery in Children after Functional Hemispherectomy
This article analyzed the locomotive recovery of children after functional hemispherectomy. 12 patients were used in the student after giving informed consent. The requirements for being in the study were to be 3 years of age or higher so as to be able to properly follow commands, ability to walk without physical assistance at baseline, no behavioral issues from children, and unwavering commitments from the patients involved. Mental age was estimated using the Peabody Picture Vocabulary Test. Typical locomotive rehabilitation training involved stretching, a 30 minute walking session on a treadmill, a 30 minute walking session on ground and encouragement from the parents by following along. One morning session and one evening session were required 5 days a week. According to caregivers who were present during the entirety of locomotive rehabilitation, they noticed that their children walked straighter and with less of a limp after rehabilitation. Increased quadricep and calf strength were reported in all patients. And of the 8 patients who were using an ankle-foot orthosis prior to training were able to discontinue use after just 2 weeks of therapy. While subjective reportings of improved motor skills were made, locomotive impairment remained in many of the patients.
Citation:
Stella de Bode, Gary W. Mathern, Susan Bookheimer, and Bruce Dobkin 2007.
Neurorehabilitation and Neural Repair 21(6): 497-508.
Safety of Hemispherectomy
This article discussed and verified the safety of hemispherectomy as a procedure for children to undergo as a treatment for drug-resistant epilepsy as well as therapy-resistant epilepsy. Both pre and post-operative cognitive and physical evaluations were performed to compare the differences. 12 patients were analyzed aged from 18 to 56 years old. All patients underwent hemispherectomy between the years of 1997-2016. Medical history, including seizure semiology, family history of seizure, detailed neurological examination, and neuropsychological assessment were required. Functional Magnetic Resonance Imaging (fMRI) was used to analyze the patients’ anatomy. In 5 patients, postoperative neurological status remained largely unchanged. In all 8 of the neuropsychologically evaluated patients, language was not impaired and 2 of the patients had improvements with memory and attention. In all of the patients, seizures situations significantly improved. By the last follow-up, 10 of the 12 patients remained free of disabling seizures, while the other 2 experienced persistent seizures. 2 of the patients passed away post-surgery, yet both of these untimely deaths were unrelated to the hemispherectomies.
Citation:
Schmeiser, B., Sentner, J., Steinhoff, B.J., Schulze-Bonhage, A., Kogias, E., Wendling, A., and Hammen, T. 2017. Functional hemispherectomy is safe and effective in adult patients with epilepsy. Epilepsy and Behavior 77: 19-25.
Feline Hemispherectomy
This study analyzed the recovery of function of cats who underwent hemispherectomy whether neonatally or as an adult. 24 kittens and 14 adult male cats were used. 12 of the kittens(9 male and 3 female) were given hemispherectomies at a median age of 8 days. The other 12 of the litter were used as controls. In terms of neurological assessment, battery of motor, sensory, and gross behavioral tests were used. Each of these tests were administered post-surgically, frequently within the first few days of recovery, and ceased after about 5 months once post-surgical changes ceased. To reiterate, none of these animals had any sort of neurologic condition such as epilepsy, which is typically the cause for hemispherectomy in human patients. At the end of neurologic testing, each of the animals were deeply anesthetized and euthanized via cardiac perfusion of saline. Their brains were then surgically removed from their skulls for neuroanatomical analysis. All of the neo-natal lesioned kittens grew to an adult size and weight considered within normal ranges for their age and breed.
Citation:
Villablance, Jaime R., Burgess, J.Wesley, and Olmstead, Charles E. 1986. Recovery of function after neonatal or adult hemispherectomy in cats: I. Time course, movement, posture and sensorimotor tests. Behavioral Brain Research 19: 205-226.
Surgical Technique Comparison
This article analyzed two different surgical techniques of hemispherectomy for Intractable Epilepsy in childhood. The 2 different neurosurgical procedures analyzed for comparison were hemidecortication (HD) and peri-insular hemispherectomy (PIH). The main comparison made was not the efficacy nor efficiency of each procedure, rather it was the patient outcome of both procedures that was compared. 21 and 20 children received each procedure respectively. 6 of the patients who received HD required a second surgery and 3 patients required a third surgery. Of the PIH patients, only one required a second procedure. In terms of post-operative shunting, 5 HD patients needed it and only one PIH patient needed it. The conclusion of the study was the the PIH method of hemispherectomy resulted in more favorable seizure outcomes and less post-operative complications than the HD method of hemispherectomy.
Citation:
Kwan, A., Ng, W.H., Otsubo, H., Ochi, A., Snead, O.C III, Tamber, M., and Rutka, J. 2010. Hemispherectomy for the control of Intractable Epilepsy in Childhood: Comparison of 2 surgical techniques in a Single Institution. Operative Neurosurgery 67: 429-436.
Indications and Outcomes
This article is from a medical journal that analyzed specifically the outcomes and indications of hemispherectomy. The patients in the study all had drug-resistant focal epilepsies, meaning their seizures would originate from a focal point in one hemisphere of the brain and travel throughout the brain to the other hemisphere via the corpus callosum. While split brain procedures have been shown to reduce seizures, both in magnitude and frequency, hemispherectomy has been shown to reduce seizure by a much more substantial margin, often times eliminating the seizures completely. The purpose of hemispherectomy is to eradicate the epileptogenic area of the brain, hopefully eradicating the entirety of one’s seizures. Seizure outcomes differ greatly depending on seizure etiology and surgical technique used. Patients with acquired lesions and congenital malformations of cortical development have a seizure-free rate of 60-90% after surgery. Anatomic hemispherectomy is beneficial in terms of seizure outcome compared to hemispherotomy due to the complete severing of connection between the 2 hemispheres. However, anatomical hemispherectomies are considered to be a higher risk for postoperative complications.
Citation:
Kim, J.S., Park, E.K., Shim, K.W., and Kim, D.S. 2018. Hemispherectomy and Functional Hemispherectomy: Indications and Outcomes. Journal of Epilepsy Research 8: 1-5.
Speech-Language Outcomes
Hemispherectomy of left hemispheres would theoretically leave someone mute and illiterate, as well as unable to comprehend language as a whole. This article analyzed the speech and language outcomes of children AND young adults who underwent anatomical hemispherectomies to treat their drug-resistant focal epilepsy. Most children who underwent left hemispherectomy had IQs that were in the range of severe cognitive deficit, meaning way below average. Their language related scores were computed based on mental age and not chronological age. Patients with left hemispherectomy were deemed more likely to show syntactic comprehension and rapid-rate auditory processing deficits than their right hemispherectomy counterparts. Both groups, however, were similar to normal children in speech production.
Citation:
Stark, R.E., Bleile, K., Freeman, J., and Vining, E.P.G. 1995. Speech-Language Outcomes of Hemispherectomy in Children and Young Adults. Brain and Language 51: 406-421.