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X Rodriguez-Osorio, F J Lopez-Gonzalez, J Eiris-Punal, C Frieiro-Dantas, C Gomez-Lado, M Peleteiro-Fernandez, A Prieto-Gonzalez
INTRODUCTION: Functional hemispherectomy consists in palliative epilepsy surgical procedure usually performed in patients with pharmaco-resistant epilepsy and hemispheric syndromes. It is based on the neural disconnection of the affected hemisphere with preservation of the vascular supply. AIM: To analyze long-term prognosis and safety of the hemispherectomies performed in our institution. PATIENTS AND METHODS: Retrospective analysis collecting the following variables: age, gender, age of epilepsy onset, type of seizures, etiology, age of epilepsy surgery, prognosis and potential surgical complications...
March 1, 2018: Revista de Neurologia
Sichang Chen, Yuguang Guan, Changqing Liu, Xiuyu Du, Yao Zhang, Shuai Chen, Jie Wang, Tianfu Li, Guoming Luan
BACKGROUND: Hemispherectomy is useful for treating patients with intractable epilepsy caused by diffuse unilateral hemispheric disease. Few patients develop recurrent seizures after hemispherectomy, but managing epilepsy by medical means alone is challenging for these patients, and it is also difficult to determine the treatment options and assess the need for reoperation. OBJECTIVE: To present the treatment strategies and outcomes of patients who developed recurrent intractable epilepsy after initial hemispherectomies that were performed at a single institution by a single surgeon between 2004 and 2014...
December 5, 2017: Epilepsy Research
Michael Nahm, David Rousseau, Bruce Greyson
Neuroscientists typically assume that human mental functions are generated by the brain and that its structural elements, including the different cell layers and tissues that form the neocortex, play specific roles in this complex process. Different functional units are thought to complement one another to create an integrated self-awareness or episodic memory. Still, findings that pertain to brain dysplasia and brain lesions indicate that in some individuals there is a considerable discrepancy between the cerebral structures and cognitive functioning...
December 2017: Journal of Nervous and Mental Disease
Allen L Ho, Arjun V Pendharkar, Eric S Sussman, May Casazza, Gerald A Grant
Hemispherectomy is a highly effective treatment option for children with severe, unilateral, medically refractory epilepsy. Many patients undergoing hemispherectomy are younger patients with dysmorphic brains, making accomplishing a complete disconnection challenging due to anatomic distortion, even with the aid of intraoperative navigation. Diffusion tensor imaging (DTI) has been proposed as a valuable imaging adjunct perioperatively to help guide surgeons intraoperatively, as well as for post-surgical evaluation and confirmation of complete hemispheric disconnection...
September 18, 2017: Curēus
Mashael AlKhateeb, Richard McLachlan, Jorge Burneo, David Diosy, Seyed Mirsattari
Septo-optic dysplasia (SOD) is a rare disorder associated with optic nerve hypoplasia, pituitary abnormalities and agenesis/dysgenesis of midline brain structures including the septum pellucidum and corpus callosum. Though sometimes associated with drug-resistant epilepsy, this association has not been well studied. We report six SOD patients with associated malformation of cortical development (MCD) and drug-resistant epilepsy who underwent video-EEG telemetry at our centre between 1998 and 2016 for drug-resistant epilepsy...
2017: Epilepsy & Behavior Case Reports
Jiqing Qiu, Yu Cui, Bin Qi, Lichao Sun, Zhanpeng Zhu
No abstract text is available yet for this article.
September 15, 2017: Clinics and Practice
Anthony C Wang, George M Ibrahim, Andrew V Poliakov, Page I Wang, Aria Fallah, Gary W Mathern, Robert T Buckley, Kelly Collins, Alexander G Weil, Hillary A Shurtleff, Molly H Warner, Francisco A Perez, Dennis W Shaw, Jason N Wright, Russell P Saneto, Edward J Novotny, Amy Lee, Samuel R Browd, Jeffrey G Ojemann
OBJECTIVE The potential loss of motor function after cerebral hemispherectomy is a common cause of anguish for patients, their families, and their physicians. The deficits these patients face are individually unique, but as a whole they provide a framework to understand the mechanisms underlying cortical reorganization of motor function. This study investigated whether preoperative functional MRI (fMRI) and diffusion tensor imaging (DTI) could predict the postoperative preservation of hand motor function. METHODS Thirteen independent reviewers analyzed sensorimotor fMRI and colored fractional anisotropy (CoFA)-DTI maps in 25 patients undergoing functional hemispherectomy for treatment of intractable seizures...
November 3, 2017: Journal of Neurosurgery. Pediatrics
Qun Wang, Zhanpeng Zhu, Guangming Wang, Lichao Sun, Jiqing Qiu
BACKGROUND: Rasmussen encephalitis (RE) is a rare and severe brain disorder associated with unilateral hemispheric atrophy, manifesting as severe refractory epilepsy, hemiplegia, defects of motor and speech functions, and cognitive impairment. Treatment of RE, especially in adult patients, is extremely challenging. Herein, we report the case of an adult patient with RE who was treated with a functional hemispherectomy and achieved a favorable prognosis. CASE REPORT: A 29-year-old woman presented with a 24-year history of epileptic seizures...
September 26, 2017: Turkish Neurosurgery
Luca Sebastianelli, Leopold Saltuari, Raffaele Nardone
No abstract text is available yet for this article.
September 2017: Neural Regeneration Research
Barbara Schmeiser, Josef Zentner, Bernhard Jochen Steinhoff, Andreas Schulze-Bonhage, Evangelos Kogias, Anne-Sophie Wendling, Thilo Hammen
INTRODUCTION: Functional hemispherectomy (FH) is a well-established therapeutic option for children with epilepsy with parenchymal damage confined to one hemisphere, yet its application in adults remains rare. The intention of our study was to investigate postoperative clinical and epileptological outcome in adults who received FH for intractable epilepsy. MATERIALS AND METHODS: We retrospectively analyzed 12 adult patients (18-56years) with intractable epilepsy due to unihemispheric pathology...
December 2017: Epilepsy & Behavior: E&B
Rajesh Shankar Iyer, Ravi Mohan Rao, Karunakaran Muthukalathi, Praveen Kumar
Hemispherotomy is the currently preferred surgical treatment option for refractory unihemispheric epilepsies. The incidence of hydrocephalus is greatly reduced in this disconnective procedure when compared with the resective procedure of anatomical hemispherectomy. We describe the occurrence of ipsilateral trapped lateral ventricle months after hemispherotomy for Rasmussen's encephalitis. There is enough evidence to suggest that this rare and interesting complication is due to the local inflammatory changes associated with the surgical trauma...
October 19, 2017: BMJ Case Reports
Carolyn M Benson, Holger Joswig, H Brian Evans, David A Steven
BACKGROUND AND IMPORTANCE: Extensive cerebral resections for the treatment of epilepsy may result in a large intracranial dead space that is prone to recurrent hemorrhage, either due to mechanical dislodgement or the development of extensive subdural membranes. Several techniques have been proposed to decrease the risk of hemorrhage by either reducing or filling the remaining intracranial dead space. CLINICAL PRESENTATION: We present a case of persistent hemorrhage following functional hemispherectomy in a patient with a large porencephalic cyst...
July 20, 2017: Operative Neurosurgery (Hagerstown, Md.)
Gun-Ha Kim, Joo Hee Seo, James E Baumgartner, Fatima Ajmal, Ki Hyeong Lee
BACKGROUND: The insular cortex is not routinely removed in modified functional hemispherectomy due to the risk of injury to the main arteries and to deep structures. Our study evaluates the safety and usefulness of applying intraoperative electrocorticography (ECoG) on the insular during the hemispherectomy. METHODS: We included all patients who underwent insular ECoG during a modified functional hemispherectomy from 2012 to 2015. After the surgery, the decision for further resection of the insular cortex was made based on the presence of electrographic seizures on ECoG...
August 25, 2017: BMC Neurology
Georgia Ramantani, Hans Holthausen
The risk of unprovoked seizures in population-based cohorts of cerebral infection survivors is 7-8% in developed countries, rising to considerably higher rates in resource-poor countries. The main risk factors for epilepsy after cerebral infection, besides acute seizures, are infection-associated brain lesions and status epilepticus during the acute phase. Despite the high prevalence of pharmacoresistant epilepsies after cerebral infections, especially in patients with MRI-identifiable lesions, only a small minority undergoes epilepsy surgery...
June 1, 2017: Epileptic Disorders: International Epilepsy Journal with Videotape
Robyn Whitney, Sameer AlMehmadi, Bláthnaid McCoy, Ivanna Yau, Ayako Ochi, Hiroshi Otsubo, Shelly K Weiss, James Rutka, Lili-Naz Hazrati, O Carter Snead, Cristina Go
BACKGROUND: The presence of cerebral astrocytic inclusions recently has been described in a subset of children with early-onset refractory epilepsy, with or without structural brain malformations, and varying degrees of developmental delay. METHODS: We describe two new individuals with epilepsy with astrocytic inclusions and suggest that in some children this disorder may represent a unique hemispheric epilepsy. We review previously reported individuals with epilepsy with astrocytic inclusions...
April 18, 2017: Pediatric Neurology
Yasushi Iimura, Kevin Jones, Kyoko Hattori, Yushi Okazawa, Atsuko Noda, Kana Hoashi, Yutaka Nonoda, Eishi Asano, Tomoyuki Akiyama, Cristina Go, Ayako Ochi, O Carter Snead, Elizabeth J Donner, James T Rutka, James M Drake, Hiroshi Otsubo
OBJECTIVE: Subtotal hemispherectomy involves the resection of multiple lobes in children with drug-resistant epilepsy, skipping the motor area (MA). We determined epileptogenicity using the occurrence rate (OR) of high-frequency oscillations (HFOs) and the modulation index (MI), demonstrating strength of coupling between HFO and slow wave. We hypothesized that epileptogenicity increased over the multiple lobes but skipped the MA. METHODS: We analyzed 23 children (14 subtotal hemispherectomy; 9 multilobar resections)...
July 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Anna Ivanova, Eran Zaidel, Noriko Salamon, Susan Bookheimer, Lucina Q Uddin, Stella de Bode
In rare cases of severe and intractable epilepsy, cerebral hemispherectomy is performed to arrest seizure activity and improve quality of life. The remaining hemisphere is often capable of supporting many cognitive functions post-surgery, although the outcome depends on the underlying etiology, hemisphere removed, and age of resection. The mechanisms underlying this massive reorganization are at present unknown. Here we examined intrinsic functional connectivity of putative language brain networks in four children after left cerebral hemispherectomy using resting-state functional magnetic resonance imaging (rsfMRI)...
November 2017: Brain Structure & Function
Courtney M Schusse, Kris Smith, Cornelia Drees
OBJECTIVE Hemispherectomy is a surgical technique that is established as a standard treatment in appropriately selected patients with drug-resistant epilepsy. It has proven to be successful in pediatric patients with unilateral hemispheric lesions but is underutilized in adults. This study retrospectively evaluated the clinical outcomes after hemispherectomy in adult patients with refractory epilepsy. METHODS This study examined 6 cases of hemispherectomy in adult patients at Barrow Neurological Institute. In addition, all case series of hemispherectomy in adult patients were identified through a literature review using MEDLINE and PubMed...
April 28, 2017: Journal of Neurosurgery
Ammar H Hawasli, Ravi Chacko, Nicholas P Szrama, David T Bundy, Mrinal Pahwa, Chester K Yarbrough, Brian J Dlouhy, David D Limbrick, Dennis L Barbour, Matthew D Smyth, Eric C Leuthardt
Objectives: Hemispheric disconnection has been used as a treatment of medically refractory epilepsy and evolved from anatomic hemispherectomy to functional hemispherectomies to hemispherotomies. The hemispherotomy procedure involves disconnection of an entire hemisphere with limited tissue resection and is reserved for medically-refractory epilepsy due to diffuse hemispheric disease. Although it is thought to be effective by preventing seizures from spreading to the contralateral hemisphere, the electrophysiological effects of a hemispherotomy on the ipsilateral hemisphere remain poorly defined...
2017: Frontiers in Human Neuroscience
Luca Sebastianelli, Viviana Versace, Alexandra Taylor, Francesco Brigo, Wolfgang Nothdurfter, Leopold Saltuari, Eugen Trinka, Raffaele Nardone
Hemispherectomy (HS) is an effective surgical procedure aimed at managing otherwise intractable epilepsy in cases of diffuse unihemispheric pathologies. Neurological recovery in subjects treated with HS is not limited to seizure reduction, rather, sensory-motor and behavioral improvement is often observed. This outcome highlights the considerable capability of the brain to react to such an extensive lesion, by functionally reorganizing and rewiring the cerebral cortex, especially early in life. In this narrative review, we summarize the animal studies as well as the human neurophysiological and neuroimaging studies dealing with the reorganizational processes that occur after HS...
April 13, 2017: Brain Research Bulletin
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