Objective

To evaluate outcomes from hemispherectomy and callosotomy related to the need for anti-seizure medication (ASM), seizure frequency, and cognition.

Methods

A review of the medical charts of all Danish pediatric patients who underwent hemispherectomy or callosotomy from January 1996 to December 2019 for preoperative and postoperative ASM use, seizure frequency, and cognitive data.

Results

The median age of epilepsy onset was two years (interquartile range (IQR): 0.0–5.3) for the hemispherectomy patients (n = 16) and one year (IQR: 0.6–1.7) for callosotomy patients (n = 5). Median time from onset to final surgery was 3.4 years for hemispherectomy and 10.2 years for callosotomy, while the median follow-up time was 6.9 years and 9.0 years, respectively. Preoperatively, all patients had daily seizures and were treated with ≥ 2 ASM. Hemispherectomy resulted in a reduction in seizure frequency in 87.5 % of patients, with 78.6 % achieving seizure freedom. Furthermore, 81.3 % experienced a reduction in ASM use and 56.3 % stopped all ASM. Median IQ/developmental quotient (IQ/DQ) was low preoperatively (44.0 [IQR: 40.0–55.0]) and remained unchanged postoperatively (IQ change: 0.0 [IQR: −10.0–+4.0]). Callosotomy resulted in a seizure reduction of 86–99 % in four patients, and ASM could be reduced in three patients. Median IQ/DQ was 20.0 preoperatively (IQR: 20.0–30.0) and remained unchanged postoperatively (IQ change: 0.0 [IQR: 0.0]).

Conclusion

Hemispherectomy and callosotomy result in a substantial reduction in seizure frequency and ASM use without deterioration of IQ. Extensive epilepsy surgery should be considered early in children with drug-resistant epilepsy.

中文翻译：

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丹麦小儿难治性癫痫半球切除术和胼胝体切开术的现状

客观的

评估与抗癫痫药物 (ASM) 需求、癫痫发作频率和认知相关的半球切除术和胼胝体切开术的结果。

方法

对 1996 年 1 月至 2019 年 12 月期间接受半球切除术或胼胝体切开术的所有丹麦儿科患者的病历进行了回顾，以了解术前和术后 ASM 使用情况、癫痫发作频率和认知数据。

结果

半球切除术患者 (n = 16) 的癫痫发病中位年龄为 2 岁（四分位距 (IQR)：0.0–5.3），胼胝切开术患者 (n = 5) 的癫痫发病中位年龄为 1 岁（IQR：0.6–1.7）。半球切除术从发病到最终手术的中位时间为 3.4 年，胼胝体切开术为 10.2 年，而中位随访时间分别为 6.9 年和 9.0 年。术前，所有患者均每日癫痫发作，并接受≥2次ASM治疗。大脑半球切除术使 87.5% 的患者癫痫发作频率降低，其中 78.6% 的患者实现了癫痫发作消除。此外，81.3% 的人减少了 ASM 的使用，56.3% 的人停止了所有 ASM。术前中位智商/发育商数 (IQ/DQ) 较低 (44.0 [IQR: 40.0–55.0])，术后保持不变 (IQ 变化：0.0 [IQR: −10.0–+4.0])。胼胝体切开术使 4 名患者的癫痫发作减少了 86-99%，并且 ASM 可以减少 3 名患者的癫痫发作。术前 IQ/DQ 中位数为 20.0（IQR：20.0-30.0），术后保持不变（IQ 变化：0.0 [IQR：0.0]）。

结论

大脑半球切除术和胼胝体切开术可大幅减少癫痫发作频率和 ASM 的使用，而不会降低智商。对于耐药性癫痫儿童，应尽早考虑进行广泛的癫痫手术。