Hemispheric surgery can treat severe epilepsy in children
Keywords:Aivopuoliskon hermoyhteyksien katkaisuleikkauksella saavutetaan hyviä tuloksia vaikeahoitoisen epilepsian hoidossa lapsipotilailla. Suurin osa potilaista ei saanut neurokirurgisen leikkauksen jälkeen enää epilepsiakohtauksia.
Medical student and doctoral researcher Vincent Zheng. Photo: Hanna Raijas-Turva / HUS
About one-third of children with epilepsy have a form that cannot be controlled with medication. For some of them, a neurosurgical treatment option can be considered if the area of the brain causing the epilepsy can be localized and its removal does not cause significant harm to the patient.
"If the cause of the patient's epilepsy is a significantly damaged hemisphere, this damaged side can be isolated from the healthy side by severing all its connections with brain surgery," explains medical student and doctoral researcher Vincent Zheng.
In Finland, surgeries to disconnect the connections between brain hemispheres have been performed on pediatric patients who need them mainly at the New Children's Hospital. HUS operates a multidisciplinary Epilepsia-Helsinki program that evaluates the treatment of severe, drug-resistant epilepsy. Epilepsy Helsinki is a member of the European Reference Network for Epilepsy, ERN EpiCARE.
Surgery led to seizure freedom and had a favorable impact on cognitive development
"We wanted to find out how many of the operated patients completely become seizure free and which factors influence this. Additionally, we studied how the surgery affects the patients' cognitive development," says Zheng.
Of the 48 patients operated in HUS between 1991 and 2022, 73% achieved seizure freedom after the first surgery, and after additional surgeries, 88% of the patients were seizure free. The patients were operated at an average age of 7 years. The study also found that 16 patients had residual connections after the first surgery. Of these patients, 7 were seizure-free regardless of these connections. Most patients' cognitive development either accelerated or remained stable.
“Surgery to disconnect the connections from the damaged brain hemisphere is an effective treatment for severe, drug-resistant epilepsy in properly selected patients, as it eliminates seizures and has a favorable impact on cognitive development.”
Research article: Outcomes and complications of vertical parasagittal hemispherotomy in children: a nationwide population-based study
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