Outcome after hemispherotomy in patients with intractable epilepsy: Comparison of techniques in the Italian experience

Luca de Palma, Nicola Pietrafusa, Francesca Gozzo, Carmen Barba, Giusy Carfi-Pavia, Massimo Cossu, Alessandro De Benedictis, Lorenzo Genitori, Flavio Giordano, Giorgio Lo Russo, Carlo Efisio Marras, Veronica Pelliccia, Susanna Rizzi, Camilla Rossi-Espagnet, Federico Vigevano, Renzo Guerrini, Laura Tassi, Nicola Specchio

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The objective of the study was to evaluate clinical characteristics and outcome of hemispherotomy in children and adolescents with hemispheric refractory epilepsy in an Italian cohort of patients.

METHODS: We retrospectively evaluated the clinical course and outcome of 92 patients with refractory epilepsy who underwent hemispherotomy in three Italian epilepsy centers between 2006 and 2016. Three different approaches for hemispherotomy were used: parasagittal, modified parasagittal, and lateral.

RESULTS: Mean age at epilepsy onset was 1.8 ± 2.51 years, and mean duration of epilepsy prior to surgery was 7.4 ± 5.6 years. Mean age at surgery was 9.2 ± 8.0 years. After a mean follow-up of 2.81 ± 2.4 years, 66 of 90 patients (two lost from follow-up, 73.3%) were seizure-free (Engel class I). The etiology of epilepsy was related to acquired lesions (encephalomalacia or gliosis) in 44 patients (47.8%), congenital malformations (cortical dysplasia, hemimegalencephaly, other cortical malformations) in 38 (41.3%), and progressive conditions (Rasmussen or Sturge-Weber syndrome) in 10 patients (10.9%). Regarding seizure outcome, we could not identify statistically significant differences between vertical and lateral approaches (p = 0.154). Seizure outcome was not statistically different in patients with congenital vs acquired or progressive etiologies (p = 0.43). Acute postoperative seizures (APOS) correlated with poor outcome (p < 0.05). On multivariate analysis, presurgical focal to bilateral tonic-clonic seizures (Odds Ratio (OR) = 3.63, 95% Confidence Interval (CI): 1.86-15.20, p = 0.048) independently predicted seizure recurrence. Twenty-one patients (22.8%) exhibited postoperative complications, with no unexpected and persistent neurological deficit. More than 50% of the patients completely tapered drugs.

SIGNIFICANCE: Our data confirm hemispherotomy to be a safe and effective procedure in patients with drug resistant epilepsies due to hemispheric lesions. Presurgical focal to bilateral tonic-clonic seizures are the strongest predictor of seizure recurrence after surgery, independently from the type of hemispherotomy.

Original languageEnglish
Pages (from-to)22-28
Number of pages7
JournalEpilepsy and Behavior
Volume93
DOIs
Publication statusE-pub ahead of print - Feb 16 2019

Fingerprint

Seizures
Epilepsy
Encephalomalacia
Sturge-Weber Syndrome
Drug Resistant Epilepsy
Malformations of Cortical Development
Recurrence
Gliosis
Age of Onset
Multivariate Analysis
Odds Ratio
Confidence Intervals
Pharmaceutical Preparations

Cite this

Outcome after hemispherotomy in patients with intractable epilepsy : Comparison of techniques in the Italian experience. / de Palma, Luca; Pietrafusa, Nicola; Gozzo, Francesca; Barba, Carmen; Carfi-Pavia, Giusy; Cossu, Massimo; De Benedictis, Alessandro; Genitori, Lorenzo; Giordano, Flavio; Russo, Giorgio Lo; Marras, Carlo Efisio; Pelliccia, Veronica; Rizzi, Susanna; Rossi-Espagnet, Camilla; Vigevano, Federico; Guerrini, Renzo; Tassi, Laura; Specchio, Nicola.

In: Epilepsy and Behavior, Vol. 93, 16.02.2019, p. 22-28.

Research output: Contribution to journalArticle

de Palma, Luca ; Pietrafusa, Nicola ; Gozzo, Francesca ; Barba, Carmen ; Carfi-Pavia, Giusy ; Cossu, Massimo ; De Benedictis, Alessandro ; Genitori, Lorenzo ; Giordano, Flavio ; Russo, Giorgio Lo ; Marras, Carlo Efisio ; Pelliccia, Veronica ; Rizzi, Susanna ; Rossi-Espagnet, Camilla ; Vigevano, Federico ; Guerrini, Renzo ; Tassi, Laura ; Specchio, Nicola. / Outcome after hemispherotomy in patients with intractable epilepsy : Comparison of techniques in the Italian experience. In: Epilepsy and Behavior. 2019 ; Vol. 93. pp. 22-28.
@article{5c0decac41a241f4808a976d8dfed46a,
title = "Outcome after hemispherotomy in patients with intractable epilepsy: Comparison of techniques in the Italian experience",
abstract = "OBJECTIVE: The objective of the study was to evaluate clinical characteristics and outcome of hemispherotomy in children and adolescents with hemispheric refractory epilepsy in an Italian cohort of patients.METHODS: We retrospectively evaluated the clinical course and outcome of 92 patients with refractory epilepsy who underwent hemispherotomy in three Italian epilepsy centers between 2006 and 2016. Three different approaches for hemispherotomy were used: parasagittal, modified parasagittal, and lateral.RESULTS: Mean age at epilepsy onset was 1.8 ± 2.51 years, and mean duration of epilepsy prior to surgery was 7.4 ± 5.6 years. Mean age at surgery was 9.2 ± 8.0 years. After a mean follow-up of 2.81 ± 2.4 years, 66 of 90 patients (two lost from follow-up, 73.3{\%}) were seizure-free (Engel class I). The etiology of epilepsy was related to acquired lesions (encephalomalacia or gliosis) in 44 patients (47.8{\%}), congenital malformations (cortical dysplasia, hemimegalencephaly, other cortical malformations) in 38 (41.3{\%}), and progressive conditions (Rasmussen or Sturge-Weber syndrome) in 10 patients (10.9{\%}). Regarding seizure outcome, we could not identify statistically significant differences between vertical and lateral approaches (p = 0.154). Seizure outcome was not statistically different in patients with congenital vs acquired or progressive etiologies (p = 0.43). Acute postoperative seizures (APOS) correlated with poor outcome (p < 0.05). On multivariate analysis, presurgical focal to bilateral tonic-clonic seizures (Odds Ratio (OR) = 3.63, 95{\%} Confidence Interval (CI): 1.86-15.20, p = 0.048) independently predicted seizure recurrence. Twenty-one patients (22.8{\%}) exhibited postoperative complications, with no unexpected and persistent neurological deficit. More than 50{\%} of the patients completely tapered drugs.SIGNIFICANCE: Our data confirm hemispherotomy to be a safe and effective procedure in patients with drug resistant epilepsies due to hemispheric lesions. Presurgical focal to bilateral tonic-clonic seizures are the strongest predictor of seizure recurrence after surgery, independently from the type of hemispherotomy.",
author = "{de Palma}, Luca and Nicola Pietrafusa and Francesca Gozzo and Carmen Barba and Giusy Carfi-Pavia and Massimo Cossu and {De Benedictis}, Alessandro and Lorenzo Genitori and Flavio Giordano and Russo, {Giorgio Lo} and Marras, {Carlo Efisio} and Veronica Pelliccia and Susanna Rizzi and Camilla Rossi-Espagnet and Federico Vigevano and Renzo Guerrini and Laura Tassi and Nicola Specchio",
note = "Copyright {\circledC} 2019 Elsevier Inc. All rights reserved.",
year = "2019",
month = "2",
day = "16",
doi = "10.1016/j.yebeh.2019.01.006",
language = "English",
volume = "93",
pages = "22--28",
journal = "Epilepsy and Behavior",
issn = "1525-5050",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Outcome after hemispherotomy in patients with intractable epilepsy

T2 - Comparison of techniques in the Italian experience

AU - de Palma, Luca

AU - Pietrafusa, Nicola

AU - Gozzo, Francesca

AU - Barba, Carmen

AU - Carfi-Pavia, Giusy

AU - Cossu, Massimo

AU - De Benedictis, Alessandro

AU - Genitori, Lorenzo

AU - Giordano, Flavio

AU - Russo, Giorgio Lo

AU - Marras, Carlo Efisio

AU - Pelliccia, Veronica

AU - Rizzi, Susanna

AU - Rossi-Espagnet, Camilla

AU - Vigevano, Federico

AU - Guerrini, Renzo

AU - Tassi, Laura

AU - Specchio, Nicola

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/2/16

Y1 - 2019/2/16

N2 - OBJECTIVE: The objective of the study was to evaluate clinical characteristics and outcome of hemispherotomy in children and adolescents with hemispheric refractory epilepsy in an Italian cohort of patients.METHODS: We retrospectively evaluated the clinical course and outcome of 92 patients with refractory epilepsy who underwent hemispherotomy in three Italian epilepsy centers between 2006 and 2016. Three different approaches for hemispherotomy were used: parasagittal, modified parasagittal, and lateral.RESULTS: Mean age at epilepsy onset was 1.8 ± 2.51 years, and mean duration of epilepsy prior to surgery was 7.4 ± 5.6 years. Mean age at surgery was 9.2 ± 8.0 years. After a mean follow-up of 2.81 ± 2.4 years, 66 of 90 patients (two lost from follow-up, 73.3%) were seizure-free (Engel class I). The etiology of epilepsy was related to acquired lesions (encephalomalacia or gliosis) in 44 patients (47.8%), congenital malformations (cortical dysplasia, hemimegalencephaly, other cortical malformations) in 38 (41.3%), and progressive conditions (Rasmussen or Sturge-Weber syndrome) in 10 patients (10.9%). Regarding seizure outcome, we could not identify statistically significant differences between vertical and lateral approaches (p = 0.154). Seizure outcome was not statistically different in patients with congenital vs acquired or progressive etiologies (p = 0.43). Acute postoperative seizures (APOS) correlated with poor outcome (p < 0.05). On multivariate analysis, presurgical focal to bilateral tonic-clonic seizures (Odds Ratio (OR) = 3.63, 95% Confidence Interval (CI): 1.86-15.20, p = 0.048) independently predicted seizure recurrence. Twenty-one patients (22.8%) exhibited postoperative complications, with no unexpected and persistent neurological deficit. More than 50% of the patients completely tapered drugs.SIGNIFICANCE: Our data confirm hemispherotomy to be a safe and effective procedure in patients with drug resistant epilepsies due to hemispheric lesions. Presurgical focal to bilateral tonic-clonic seizures are the strongest predictor of seizure recurrence after surgery, independently from the type of hemispherotomy.

AB - OBJECTIVE: The objective of the study was to evaluate clinical characteristics and outcome of hemispherotomy in children and adolescents with hemispheric refractory epilepsy in an Italian cohort of patients.METHODS: We retrospectively evaluated the clinical course and outcome of 92 patients with refractory epilepsy who underwent hemispherotomy in three Italian epilepsy centers between 2006 and 2016. Three different approaches for hemispherotomy were used: parasagittal, modified parasagittal, and lateral.RESULTS: Mean age at epilepsy onset was 1.8 ± 2.51 years, and mean duration of epilepsy prior to surgery was 7.4 ± 5.6 years. Mean age at surgery was 9.2 ± 8.0 years. After a mean follow-up of 2.81 ± 2.4 years, 66 of 90 patients (two lost from follow-up, 73.3%) were seizure-free (Engel class I). The etiology of epilepsy was related to acquired lesions (encephalomalacia or gliosis) in 44 patients (47.8%), congenital malformations (cortical dysplasia, hemimegalencephaly, other cortical malformations) in 38 (41.3%), and progressive conditions (Rasmussen or Sturge-Weber syndrome) in 10 patients (10.9%). Regarding seizure outcome, we could not identify statistically significant differences between vertical and lateral approaches (p = 0.154). Seizure outcome was not statistically different in patients with congenital vs acquired or progressive etiologies (p = 0.43). Acute postoperative seizures (APOS) correlated with poor outcome (p < 0.05). On multivariate analysis, presurgical focal to bilateral tonic-clonic seizures (Odds Ratio (OR) = 3.63, 95% Confidence Interval (CI): 1.86-15.20, p = 0.048) independently predicted seizure recurrence. Twenty-one patients (22.8%) exhibited postoperative complications, with no unexpected and persistent neurological deficit. More than 50% of the patients completely tapered drugs.SIGNIFICANCE: Our data confirm hemispherotomy to be a safe and effective procedure in patients with drug resistant epilepsies due to hemispheric lesions. Presurgical focal to bilateral tonic-clonic seizures are the strongest predictor of seizure recurrence after surgery, independently from the type of hemispherotomy.

U2 - 10.1016/j.yebeh.2019.01.006

DO - 10.1016/j.yebeh.2019.01.006

M3 - Article

C2 - 30780077

VL - 93

SP - 22

EP - 28

JO - Epilepsy and Behavior

JF - Epilepsy and Behavior

SN - 1525-5050

ER -