Abstracts

This paper reports on two babies younger than 6 months with hemimegaloencephaly (HME) and catastrophic epilepsy submitted to functional hemispherectomy (FH) with good clinical outcome. Patient I: DMAS, a 2-months old baby have had seizures since the first postnatal hours. He had daily, frequent, left motor simple partial and tonic-clonic seizures. EEG showed intense right hemisphere epileptic discharges with some bilateral synchrony. MRI showed right HME. He was submitted to right FH. At the time of surgery, he had bad general physical and neurological (no neck support) conditions and prolonged status epilepticus. Patient II: VB, a 5 months old baby have had seizures since his first week of life. He had daily, frequent, left motor simple partial, complex partial and bilateral tonic seizures. EEG showed intense right hemisphere epileptic discharges and intense bilateral synchrony. MRI showed right HME. He was submitted to right FH. At the time of surgery, he had bad general physical and neurological (no neck support) conditions and status epilepticus. Patient I presented a slow but progressive motor and cognitive improvement, characterized by increased social contact, smiling, more vigorous spontaneous movement and increased tonus. He remained with daily facial motor simple partial seizures and sporadic generalized tonic-clonic convulsions. He has been followed as an out-patient and has not needed hospitalization for neurologic conditions after surgery. At the age of 11 months, the kid is starting to gain neck and trunk control. Patient II presented a significant decrease in seizure[acute]s frequency. He remained with daily facial motor simple partial seizures that eventually spread to the left arm; bilateral tonic seizures still ocurr 1-2 times per week. At the age of 8 months, the kid has been managed as an out-patient and did not need hospitalization for neurologic conditions after surgery; he started to gain neck control. FH is a good option in small babies bearing HME and catastrophic epilepsy. Residual facial motor simple partial seizures appeared to be related to insular cortex left connected in place. Especial attention to the disconnection of the insula is advised during this procedure. (Supported by Sao Paulo[acute]s Secretary of Health)