Long-Term Surgical Outcome and Its Predictors After Hemispherotomy for Drug-Resistant Epilepsy – a Lower-Middle-Income Country Perspective!
Nandana Jayakumari1, Karamala Yalapalli Manisha2, Ramshekhar Menon3, Ashalatha Radhakrishnan4
1Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, 2Sree Chitra Tirunal Institute for Medical Sciences and Technology, 3Neurology Dept, Sree Chitra Tirunal Institute for Medical Sciences & Technology, 4Sree Chitra Tirunal Institute for Medical Sciences & Technology
Objective:
We aimed to determine the surgical outcome and its predictors in patients undergoing hemispherotomy for drug-resistant epilepsy and compare the outcome between the pediatric age group and above
Background:
Hemispherotomy is an effective surgical approach for drug-resistant epilepsy with hemispheric epileptogenic lesions.
Design/Methods:
This is a single-center retrospective study. We assessed the relationship between the post-surgical outcome and clinical, demographic, EEG, and MRI brain characteristics using logistic regression. Also, classified patients according to their age, duration of epilepsy and assessed each patient's postoperative seizure outcome
Results:
150 patients, mean age at surgery 11.21 + 6.39 years, mean duration of seizures at time of referral 5.88 + 5.34 years and at surgery 7.86 + 6.15. 89 patients (59.3%) were of age less than 12 years (pediatric group). Most common pathology was Porencephalic cyst (33 patients, 30%), and MRI showed contralateral pathology in 15 patients (10%). EEG showed lateralized IEDs in 59 patients (39.3%) and ipsilateral ictal onset in 66 patients(44%). 71.3% were seizure-free and 78% had Engel class I outcome at last follow-up with mean follow-up of 8.42 years. Acute postoperative seizures (APOS), (OR 3.08; CI 1.23-7.69; p-value:0.016), and contralateral slowing in post-operative EEG at 1 year (OR 7.64; CI 3.25- 17.97; p-value:0.000) were independently predictive of poor seizure outcome. In survival analysis, the probability of seizure freedom was comparable between pediatric age and above, however, it was significantly higher in patients with epilepsy duration < 5 years (70% vs 50%; p value 0.047).
Conclusions:
The presence of APOS and contralateral slowing in post-operative EEG are key determinants of poor seizure outcomes. There is no difference in seizure outcome with regard to age at surgery, however, those with shorter epilepsy duration had a better outcome. This emphasizes the need to bridge the surgical treatment gap by ensuring prompt referrals and addressing obstacles preventing epilepsy surgery
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