Long term outcome of functional hemispherectomy for refractory epilepsy: Experience from a single center.
BACKGROUND
Hemispherectomy has an established role as a treatment of last resort in patients with unilateral hemispheric lesions suffering from refractory epilepsy.


METHODS
Seven patients were evaluated at our Epilepsy Unit. We compared the seizure outcome at 6 months, 1, 2, 5 years post-surgery, as well as at end follow-up (mean 7.1 years) using Engel classification. Reduction of antiepileptic drugs (AEDs) was also assessed utilizing equal time frames.


RESULTS
The mean age of seizure onset was 5.4 years. Engel I was achieved in 5 patients at 6 months (71.4%). Engel at 1 year was predicted by the Engel at 6 months (p=0.013) with a similar number of patients being classified as Engel I outcome. Engel at 2 years was also predicted by Engel at 6 months and at 1 year (p=0.030). At end follow-up only 3 patients (42.9%) remained categorized as Engel I outcome. There was a trend toward a stability in Engel classification. All patients with developmental causes for their epilepsy experienced some deterioration of the surgical outcomes. Conversely, all patients with acquired causes were stable throughout follow-up. Seizure outcome at 6 months was worse in the patients who had post-op complications (p=0.044). Adult and pediatric populations did not differ significantly in any tested variable.


CONCLUSIONS
Hemispherectomy is a valuable resource for seizure control in properly selected patients. Engel patient's evolution could be predicted at 6 months interval. Hemispherectomy could be considered a useful attitude in difficult cases.
['Sousa|Sérgio|S|', 'Sá Pinto|Vasco|V|', 'Chaves|João|J|', 'Martins da Silva|António|A|', 'Ramalheira|João|J|', 'Lopes|João|J|', 'Temudo|Teresa|T|', 'Lopes Lima|José Manuel|JM|', 'Calheiros|Alfredo|A|', 'Rangel|Rui|R|']
Hemispherectomy Refractory epilepsy Cirugía de la epilepsia Epilepsia refractaria Epilepsy surgery Hemisferectomía