Functional Outcomes Following Hemispherectomy for Patients with Intractable Seizure

Hemispherectomy (HE) is a radical and often life-saving surgery in which half of the brain is removed or disconnected to treat individuals with intractable seizure disorder. In evaluating the effectiveness of HE, most neurosurgery researchers have focused on good postsurgical seizure control as the primary indicator of a successful surgery. However, very little is known about the longer term functional outcome of HE adaptive functioning and behavioral/emotional problems. The goal of the current study was to explore the relationship between medical risk factors and functional outcome. Parents of HE patients were asked to complete the Vineland Adaptive Behavior Scale, Second Edition (Vineland-II; Sparrow, Balla, & Cicchetti, 1984; n = 50) and the Child Behavioral Checklist/4-18 (CBCL/4-18; Achenbach & Edelbrock, 1991) or the Child Behavior Checklist/1.5-5 (CBLC/1.5-5; Achenbach & Rescorla, 2000; n = 27). Their intractable seizures were due to cortical dysplasia (CD), Rasmussen\u27s syndrome (RE), infarction, or hemimegalencephaly (HME). Results revealed that only shorter presurgical seizure duration and younger age at surgery predicted adaptive functioning an average of 5 years following HE. More importantly, after controlling for intercorrelation, only longer presurgical seizure duration was uniquely associated with poorer outcome. Surprisingly, outcome was not predicted by side of resection, a fact that runs contrary to traditional theories of lateralization and has important implications for understanding the distinct mechanism of plasticity in this rare population. The potential role of etiology in explaining subclinical elevations in internalizing behavior (withdrawal, depression, and anxiety) as well as mild (subclinical) attention and thought problems was discussed