Abstracts

Hemispheric pathologies are commom etiology of intractable epilepsy in childhood. Patients may have early seizure onset and multiple seizure types. Dailly seizures or [italic]status epilepticus[/italic] are present in the majority of cases. Interictal and ictal EEG findings are usually diffuse involving even contralateral hemisphere. we analyse 27 patients submitted to hemispheric surgery with 18 years old or less, operated on from January 1996 to August 2003 at Ribeirao Preto Epilepsy Surgery Program (CIREP) using standardized protocols. All had medically intractable epilepsy. Presurgical evaluation included clinical history, neurologic examination, interictal and ictal video-EEG monitoring, structural and functional imaging, and neuropsychological testing. Seizure outcome was classified according to Engel schema. Fisher exact test and Mann-Whitney test were used for statistical analysis, and significance level was considered at [italic]p[/italic] [lt] 0.05. Patient age ranged from 11 months to 18 years old (mean: 8.85 years). Mean age at epilepsy onset was 4 years. In 22% of the patients two seizure types were present at evaluation. Seizure types included focal motor and tonic seizures (37% of patients for each), [italic]epilepsia partialis continua[/italic] (22.2%), infantile spasms (14.8%) and complex partial seizures (11.1%). Daily seizures were present in 55.5% of the patients and 40.7% had [italic]status epilepticus[/italic]. In 60% of the cases interictal EEG was unilateral. Ictal EEG was unilateral in 42%. Anatomical hemispherectomy were performed in five patients and hemispherotomy in 21. One patient was submitted to Delalande hemispherotomy techinic. There were no correlation between surgical techinic and demographic data. Surgical specimens revealed Rasmussen Syndrome (33.3%), porencephalic lesions (29.6%), CDA (18.6%), gliosis (7.4%), Sturge-Weber Syndrome (7.4%) and tuberous sclerosis (3.7%). Patients with Engel classification I and II corresponded to 59.3% of the cases, but 74% of patients had at least 90% seizure reduction. There were no correlation between patients with seizures in the first month post-operative (p=0.51) or surgical techinic (p=0.42) with outcome. Mean follow-up was 3.95 years. Two patients died in follow up. Patients with hemispheric pathologies usually has abnormal neurological development and intractable epilepsy. In our series, surgical outcome was similar when considering surgical techinic, with a worst outcome in patients with Rasmussen syndrome. All patients had a subjective improvement in quality of life, with use of less antiepileptic drugs and a cognitive improvment. In conclusion, patients submitted to hemispherec surgeries had good surgical outcome and an improvement of neurological development, even in patients witch persisted with mild frequent seizures. (Supported by FAEPA and FAPESP)