Hemispherectomy as Epilectic Treatment for Pediatric Age Group
First performed in the first half of the 20th century, the hemispherectomy is a common treatment for refractory epilepsy. However, it is still faced today with a decent amount of skepticism due to its highly invasive nature. Essentially, the procedure involves removing or fully disconnecting the diseased half of the brain for patients with epilepsy. In the 1960's and 70's, the high mortality rate due to complications from hydrocephalus caused the procedure to be controversial.
However, advances in modern medicine have decreased the risk of the procedure. Nowadays, it is typically performed in children under 2 years of age, which has the highest success rate (as age increases, success rate decreases). The success rate currently lies around 2/3, success denoting the child being seizure-free. A case study performed in October 2013 collects data to determine the success rate of hemispherectomy in the 21st century. The study took 29 data sets from various hospitals, for a total of 1102 patients under 20 years old who underwent a hemispherectomy. Of the available outcomes, 73.4% of patients returned with zero seizures, while the mortality rate (within 30 days) came out as 2.2%. In addition, the data set also gave information for the etiology, or cause, of the epilepsy. 31.6% of the patients had acquired etiology, 40.3% were developmental, and 28% were progressive.
The acquired and progressive etiologies came back with more favorable results compared to developmental (NLM). It is also important to note that there were no statistically significant differences in seizure outcomes and the type of hemispherectomy performed. The main conclusion that research scientists were able to garner from the results was that hemispherectomy is highly effective in treating refractory epilepsy in the pediatric age group, particularly for acquired and progressive etiologies. As a result, despite skepticism from society, the procedure remains to be one of the leading operations for refractory epilepsy in the pediatric population.
By Emily Wu