Radical brain surgery for infantile epilepsy

Doug Knowles knowled at ccsmtp.ccf.org
Thu Jan 21 11:26:36 EST 1993

In article <1993Jan20.220420.28025 at cs.tulane.edu> fs at cs.tulane.edu (Frank Silbermann) writes:
>A few weeks ago CNN described an operation for babies/todlers
>with uncontrollable epilepsy.
>About 35 of these small children were diagnosed as having abnormalities
>on one side of the brain only.  The doctors removed or disconnected
>the abnormal side of the brain.  About 80% were then completely
>free of seizures.  Children once expected to be profoundly retarded
>began developing fairly normally.  The doctors said that in small children
>the healthy half of the brain will take on most of the functions
>of the removed/disconnected half.
>I am curious as to what sort of long-term disabilities associated
>with children who have had this operation.  Can they indeed
>become truly normal, or are there certain abilities that
>cannot be transferred to the other side?
>Frank Silbermann	fs at cs.tulane.edu
>Tulane University	New Orleans, Louisiana  USA

Yes, this surgery is becoming accepted for a number of epileptic conditions
in young children with intractable seizures and a prognosis of poor
mental and behavioral development.  The surgery has been modified from its
original form in which the entire cortex of one hemisphere was removed.
Now, only the most diseased part of the cortex is removed and the rest
of that hemisphere is undercut to disconnect it, but is left in place with
its blood supply intact.  The outcome from this surgery is amazingly good,
especially in the youngest (under about 3) kids.  In carefully selected
patient populations, 75-85% of the patients have complete seizure control,
and even more patients have dramatic reductions in seizure frequency.  
The functional outcome varies with age, but again, the younger kids have
amazing recovery of function.  The commonest deficits are reductions of
visual fields, some variable weakness in the contralateral limbs, and 
loss of fine motor control in the contralateral hand and fingers.  They are
generally able to walk just fine and to grasp objects in the contralateral
hand, but they probably won't become concert pianists.

We perform many of these operations each year here at the Cleveland Clinic.
Several centers around the world have also had a lot of experience with
these operations.  I append a few references to journal articles that you
may wish to read.

W. Douglas Knowles, Ph.D.           knowled at ccsmtp.ccf.org
Department of Neuroscience
Cleveland Clinic Foundation
9500 Euclid Avenue, Cleveland OH USA

AU  - Honavar M, Janota I, Polkey CE
TI  - Rasmussen's encephalitis in surgery for epilepsy.
SO  - Developmental Medicine & Child Neurology 1992 Jan;34(1):3-14

UI  - 91216206
AU  - Benecke R, Meyer BU, Freund HJ
TI  - Reorganisation of descending motor pathways in patients after
      hemispherectomy and severe hemispheric lesions demonstrated by magnetic
      brain stimulation.
SO  - Experimental Brain Research 1991;83(2):419-26

AU  - Cohen LG, Roth BJ, Wassermann EM, Topka H, Fuhr P, Schultz J, Hallett M
TI  - Magnetic stimulation of the human cerebral cortex, an indicator of
      reorganization in motor pathways in certain pathological conditions.
SO  - Journal of Clinical Neurophysiology 1991 Jan;8(1):56-65

AU  - Smith SJ, Andermann F, Villemure JG, Rasmussen TB, Quesney LF
TI  - Functional hemispherectomy: EEG findings, spiking from isolated brain
      postoperatively, and prediction of outcome.
SO  - Neurology 1991 Nov;41(11):1790-4

AU  - Muller F, Kunesch E, Binkofski F, Freund HJ
TI  - Residual sensorimotor functions in a patient after right-sided
SO  - Neuropsychologia 1991;29(2):125-45

AU  - Vargha-Khadem F, Isaacs EB, Papaleloudi H, Polkey CE, Wilson J
TI  - Development of language in six hemispherectomized patients.
SO  - Brain 1991 Feb;114 ( Pt 1B):473-95

AU  - Polkey CE
TI  - The place of hemispherectomy and major cortical resection in the control
      of drug resistant epilepsy.
SO  - Acta Neurochirurgica - Supplementum 1990;50:131-3

AU  - Duchowny MS,
TI  - Surgery for intractable epilepsy: issues and outcome.
SO  - Pediatrics 1989 Nov;84(5):886-94

AU  - Vigevano F. Bertini E, Boldrini R, Bosman C, Claps D
AU  - di Capua M, di Rocco C, Rossi GF
TI  - Hemimegalencephaly and intractable epilepsy: benefits of hemispherectomy.
SO  - Epilepsia 1989 Nov-Dec;30(6):833-43

AU  - Beardsworth ED, Adams CB
TI  - Modified hemispherectomy for epilepsy: early results in 10 cases [see
SO  - British Journal of Neurosurgery 1988;2(1):73-84

AU  - Tinuper P, Andermann F, Villemure JG, Rasmussen TB, Quesney LF
TI  - Functional hemispherectomy for treatment of epilepsy associated with
      hemiplegia: rationale, indications, results, and comparison with
SO  - Annals of Neurology 1988 Jul;24(1):27-34

AU  - Green RC, Adler JR, Erba G
TI  - Epilepsy surgery in children.
SO  - Journal of Child Neurology 1988 Jul;3(3):155-66

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