Determinants of Functional Outcome after Pediatric Hemispherotomy
Corresponding Author
Georgia Ramantani MD, PhD
Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
Address correspondence to Dr Ramantani, Department of Neuropediatrics, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland. E-mail: [email protected]
Search for more papers by this authorDorottya Cserpan PhD
Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
Search for more papers by this authorMartin Tisdall MD
Department of Neurosurgery, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
Search for more papers by this authorWillem M. Otte PhD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorGeorg Dorfmüller MD, PhD
Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
Search for more papers by this authorJ. Helen Cross MD, PhD
Department of Neurology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Great Ormond Street and University College London National Institute for Health and Care Research Biomedical Research Centre Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
Search for more papers by this authorMonique van Schooneveld PhD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorPieter van Eijsden MD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorFrauke Nees PhD
Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
Search for more papers by this authorGitta Reuner MD, PhD
Institute of Education Studies, Faculty of Behavioral and Cultural Studies, University of Heidelberg, Heidelberg, Germany
Search for more papers by this authorNiklaus Krayenbühl MD, PhD
Department of Neurosurgery, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
Search for more papers by this authorJosef Zentner MD, PhD
Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
Search for more papers by this authorChristine Bulteau MD, PhD
Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
University of Paris, MC2Lab, Institute of Psychology, Boulogne-Billancourt, France
Search for more papers by this authorKees P. J. Braun MD, PhD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorCorresponding Author
Georgia Ramantani MD, PhD
Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
Address correspondence to Dr Ramantani, Department of Neuropediatrics, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland. E-mail: [email protected]
Search for more papers by this authorDorottya Cserpan PhD
Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
Search for more papers by this authorMartin Tisdall MD
Department of Neurosurgery, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
Search for more papers by this authorWillem M. Otte PhD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorGeorg Dorfmüller MD, PhD
Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
Search for more papers by this authorJ. Helen Cross MD, PhD
Department of Neurology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Great Ormond Street and University College London National Institute for Health and Care Research Biomedical Research Centre Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
Search for more papers by this authorMonique van Schooneveld PhD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorPieter van Eijsden MD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorFrauke Nees PhD
Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
Search for more papers by this authorGitta Reuner MD, PhD
Institute of Education Studies, Faculty of Behavioral and Cultural Studies, University of Heidelberg, Heidelberg, Germany
Search for more papers by this authorNiklaus Krayenbühl MD, PhD
Department of Neurosurgery, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
Search for more papers by this authorJosef Zentner MD, PhD
Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
Search for more papers by this authorChristine Bulteau MD, PhD
Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
University of Paris, MC2Lab, Institute of Psychology, Boulogne-Billancourt, France
Search for more papers by this authorKees P. J. Braun MD, PhD
Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
Search for more papers by this authorD.C. and M.T. contributed equally to this work.
C.B. and K.P.J.B. contributed equally to this work.
Abstract
Objective
We aimed to evaluate determinants of functional outcome after pediatric hemispherotomy in a large and recent multicenter cohort.
Methods
We retrospectively investigated the functional outcomes of 455 children who underwent hemispherotomy at 5 epilepsy centers in 2000–2016. We identified determinants of unaided walking, voluntary grasping with the hemiplegic hand, and speaking through Bayesian multivariable regression modeling using missing data imputation.
Results
Seventy-five percent of children were seizure-free, and 44% stopped antiseizure medication at a 5.1-year mean follow-up (range = 1–17.1). Seventy-seven percent of children could walk unaided, 8% could grasp voluntarily, and 68% could speak at the last follow-up. Children were unlikely to walk when they had contralateral magnetic resonance imaging (MRI) abnormalities (40/73, p = 0.04), recurrent seizures following hemispherotomy (62/109, p = 0.04), and moderately (50/61, p = 0.03) or severely impaired (127/199, p = 0.001) postsurgical intellectual functioning, but were likely to walk when they were older at outcome determination (p = 0.01). Children were unlikely to grasp voluntarily with the hand contralateral to surgery when they had Rasmussen encephalitis (0/61, p = 0.001) or Sturge–Weber syndrome (0/32, p = 0.007). Children were unlikely to speak when they had contralateral MRI abnormalities (30/69, p = 0.002) and longer epilepsy duration (p = 0.01), but likely to speak when they had Sturge–Weber syndrome (29/35, p = 0.01), were older at surgery (p = 0.04), and were older at outcome determination (p < 0.001).
Interpretation
Etiology and bilaterality of structural brain abnormalities were key determinants of functional outcome after hemispherotomy. Longer epilepsy duration affected language outcomes. Not surprisingly, walking and talking ability increased with older age at outcome evaluation. ANN NEUROL 2024;95:377–387
Potential Conflicts of Interest
Nothing to report.
Open Research
Data Availability Statement
The data supporting this study's findings are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| ana26830-sup-0001-TableS1.docxWord 2007 document , 20.7 KB | TABLE S1. Clinical characteristics of our cohort and their impact on the functional outcomes of speaking, walking, and grasping in univariate analysis. For each clinical characteristic, we show the number of children (N) for whom data were available and describe them as counts n (%) for categorical variables and mean (range) for continuous variables. Percentages are calculated row-wise for the available data. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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