Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients
Objective Hemispheric neurosurgery is an established treatment for severe epilepsy caused by extended unilateral brain pathology. However, it is still an unresolved question at which age surgery should best be performed. In light of decreasing plasticity and the cumulative impact of seizures and ant...
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| Veröffentlicht in: | Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2013-05, Vol.84 (5), p.529-536 |
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| container_title | Journal of neurology, neurosurgery and psychiatry |
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| creator | Althausen, Anita Gleissner, Ulrike Hoppe, Christian Sassen, Robert Buddewig, Svenja von Lehe, Marec Schramm, Johannes Elger, Christian Erich Helmstaedter, Christoph |
| description | Objective Hemispheric neurosurgery is an established treatment for severe epilepsy caused by extended unilateral brain pathology. However, it is still an unresolved question at which age surgery should best be performed. In light of decreasing plasticity and the cumulative impact of seizures and anticonvulsants on neurodevelopment, early surgery appears preferable. Methods We retrospectively investigated the medical, cognitive-behavioural and psychosocial long-term outcome (follow-up: 9.4 years (1.1–19.4)) of hemispherectomy as a function of age at surgery (early: 16 years) based on a structured postal survey in a large patient sample (N=61/81, return rate: 75%). Results At follow-up, 45 (74%) patients were seizure free. Presurgical levels of intelligence were below average in most patients (79%) and postsurgical cognition largely resembled the presurgical capacities. Best seizure outcome was obtained for early surgery patients (90% seizure free). Patients with late surgery, however, exhibited higher presurgical and postsurgical intelligence and better psychosocial achievements. Binary logistic regression identified better presurgical intelligence and higher age at surgery as positive predictors of postsurgical intelligence. Lower presurgical intelligence and postsurgical seizure freedom predicted intellectual pre-post improvements. Conclusions Our data confirm the efficacy and cognitive safety of hemispheric surgeries performed at different ages. Eligible older and high functioning patients can be perfect candidates. Presurgical intelligence serves as indicator of the functional integrity of the contralateral hemisphere, which mainly determines postsurgical cognition and psychosocial outcome. Seizure freedom promotes cognitive improvement. As many unknown factors determined age at surgery, our retrospective data neither question early surgeries nor suggest postponing surgery. |
| doi_str_mv | 10.1136/jnnp-2012-303811 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1551614526</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1551614526</sourcerecordid><originalsourceid>FETCH-LOGICAL-b434t-b5da35ca09913dde24286dd405d62fb1a308690ac0fdf5324409ea5a531091a63</originalsourceid><addsrcrecordid>eNqNkU1v1DAQhi1ERbeFOydkiQtSlTLjr02OaEVbpKVICBA3y4kn2yybj9qJ1P33OErpgQv44sP7zHg8D2OvES4RpXm_77ohE4AikyBzxGdshcrkmZTw8zlbAYg50XDKzmLcw3zy4gU7FVKYXBqxYl-3fbfLRgot76ex6lvifc3vqG3icEehqXicwo7CkbuR-6auKVA3crejyJuOG-Q0NAca4pEPbmxSFl-yk9odIr16vM_Z96uP3zY32fbL9afNh21WKqnGrNTeSV05KAqU3pNQIjfeK9DeiLpEJyE3BbgKal9rKZSCgpx2WiIU6Iw8Z--WvkPo7yeKo01DV3Q4uI76KVrUGg0qLf4DTftABUZAQt_-he77KXTpIxbXOQo9LzpRsFBV6GMMVNshNK0LR4tgZzV2VmNnNXZRk0rePDaeypb8U8EfFwnIFqCJIz085S78smYt19re_tjYK2U-39xKZdeJv1j4st3_-_nfUPKklA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1781250381</pqid></control><display><type>article</type><title>Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>Althausen, Anita ; Gleissner, Ulrike ; Hoppe, Christian ; Sassen, Robert ; Buddewig, Svenja ; von Lehe, Marec ; Schramm, Johannes ; Elger, Christian Erich ; Helmstaedter, Christoph</creator><creatorcontrib>Althausen, Anita ; Gleissner, Ulrike ; Hoppe, Christian ; Sassen, Robert ; Buddewig, Svenja ; von Lehe, Marec ; Schramm, Johannes ; Elger, Christian Erich ; Helmstaedter, Christoph</creatorcontrib><description>Objective Hemispheric neurosurgery is an established treatment for severe epilepsy caused by extended unilateral brain pathology. However, it is still an unresolved question at which age surgery should best be performed. In light of decreasing plasticity and the cumulative impact of seizures and anticonvulsants on neurodevelopment, early surgery appears preferable. Methods We retrospectively investigated the medical, cognitive-behavioural and psychosocial long-term outcome (follow-up: 9.4 years (1.1–19.4)) of hemispherectomy as a function of age at surgery (early: <7 years/intermediate: 7–16 years/late: >16 years) based on a structured postal survey in a large patient sample (N=61/81, return rate: 75%). Results At follow-up, 45 (74%) patients were seizure free. Presurgical levels of intelligence were below average in most patients (79%) and postsurgical cognition largely resembled the presurgical capacities. Best seizure outcome was obtained for early surgery patients (90% seizure free). Patients with late surgery, however, exhibited higher presurgical and postsurgical intelligence and better psychosocial achievements. Binary logistic regression identified better presurgical intelligence and higher age at surgery as positive predictors of postsurgical intelligence. Lower presurgical intelligence and postsurgical seizure freedom predicted intellectual pre-post improvements. Conclusions Our data confirm the efficacy and cognitive safety of hemispheric surgeries performed at different ages. Eligible older and high functioning patients can be perfect candidates. Presurgical intelligence serves as indicator of the functional integrity of the contralateral hemisphere, which mainly determines postsurgical cognition and psychosocial outcome. Seizure freedom promotes cognitive improvement. As many unknown factors determined age at surgery, our retrospective data neither question early surgeries nor suggest postponing surgery.</description><identifier>ISSN: 0022-3050</identifier><identifier>EISSN: 1468-330X</identifier><identifier>DOI: 10.1136/jnnp-2012-303811</identifier><identifier>PMID: 23268362</identifier><identifier>CODEN: JNNPAU</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject>Adolescent ; Adult ; Age ; Age Factors ; Age of Onset ; Behavior ; Brain - surgery ; Cognition ; Cognition - physiology ; Cognition Disorders - etiology ; Cognition Disorders - psychology ; Convulsions & seizures ; Encephalitis ; Epilepsy ; Epilepsy - surgery ; Etiology ; Expected values ; Female ; Hemispherectomy ; Humans ; Intelligence ; Intelligence Tests ; Male ; Neuropsychology ; Neurosurgery ; Neurosurgical Procedures ; Paediatric Neurosurgery ; Patients ; Postoperative Complications - psychology ; Predictive Value of Tests ; Questionnaires ; Seizures - surgery ; Social Behavior ; Socioeconomic Factors ; Surgery ; Surveys and Questionnaires ; Treatment Outcome ; Young Adult</subject><ispartof>Journal of neurology, neurosurgery and psychiatry, 2013-05, Vol.84 (5), p.529-536</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2013 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b434t-b5da35ca09913dde24286dd405d62fb1a308690ac0fdf5324409ea5a531091a63</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jnnp.bmj.com/content/84/5/529.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://jnnp.bmj.com/content/84/5/529.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77569,77600</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23268362$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Althausen, Anita</creatorcontrib><creatorcontrib>Gleissner, Ulrike</creatorcontrib><creatorcontrib>Hoppe, Christian</creatorcontrib><creatorcontrib>Sassen, Robert</creatorcontrib><creatorcontrib>Buddewig, Svenja</creatorcontrib><creatorcontrib>von Lehe, Marec</creatorcontrib><creatorcontrib>Schramm, Johannes</creatorcontrib><creatorcontrib>Elger, Christian Erich</creatorcontrib><creatorcontrib>Helmstaedter, Christoph</creatorcontrib><title>Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients</title><title>Journal of neurology, neurosurgery and psychiatry</title><addtitle>J Neurol Neurosurg Psychiatry</addtitle><description>Objective Hemispheric neurosurgery is an established treatment for severe epilepsy caused by extended unilateral brain pathology. However, it is still an unresolved question at which age surgery should best be performed. In light of decreasing plasticity and the cumulative impact of seizures and anticonvulsants on neurodevelopment, early surgery appears preferable. Methods We retrospectively investigated the medical, cognitive-behavioural and psychosocial long-term outcome (follow-up: 9.4 years (1.1–19.4)) of hemispherectomy as a function of age at surgery (early: <7 years/intermediate: 7–16 years/late: >16 years) based on a structured postal survey in a large patient sample (N=61/81, return rate: 75%). Results At follow-up, 45 (74%) patients were seizure free. Presurgical levels of intelligence were below average in most patients (79%) and postsurgical cognition largely resembled the presurgical capacities. Best seizure outcome was obtained for early surgery patients (90% seizure free). Patients with late surgery, however, exhibited higher presurgical and postsurgical intelligence and better psychosocial achievements. Binary logistic regression identified better presurgical intelligence and higher age at surgery as positive predictors of postsurgical intelligence. Lower presurgical intelligence and postsurgical seizure freedom predicted intellectual pre-post improvements. Conclusions Our data confirm the efficacy and cognitive safety of hemispheric surgeries performed at different ages. Eligible older and high functioning patients can be perfect candidates. Presurgical intelligence serves as indicator of the functional integrity of the contralateral hemisphere, which mainly determines postsurgical cognition and psychosocial outcome. Seizure freedom promotes cognitive improvement. As many unknown factors determined age at surgery, our retrospective data neither question early surgeries nor suggest postponing surgery.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Age of Onset</subject><subject>Behavior</subject><subject>Brain - surgery</subject><subject>Cognition</subject><subject>Cognition - physiology</subject><subject>Cognition Disorders - etiology</subject><subject>Cognition Disorders - psychology</subject><subject>Convulsions & seizures</subject><subject>Encephalitis</subject><subject>Epilepsy</subject><subject>Epilepsy - surgery</subject><subject>Etiology</subject><subject>Expected values</subject><subject>Female</subject><subject>Hemispherectomy</subject><subject>Humans</subject><subject>Intelligence</subject><subject>Intelligence Tests</subject><subject>Male</subject><subject>Neuropsychology</subject><subject>Neurosurgery</subject><subject>Neurosurgical Procedures</subject><subject>Paediatric Neurosurgery</subject><subject>Patients</subject><subject>Postoperative Complications - psychology</subject><subject>Predictive Value of Tests</subject><subject>Questionnaires</subject><subject>Seizures - surgery</subject><subject>Social Behavior</subject><subject>Socioeconomic Factors</subject><subject>Surgery</subject><subject>Surveys and Questionnaires</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0022-3050</issn><issn>1468-330X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU1v1DAQhi1ERbeFOydkiQtSlTLjr02OaEVbpKVICBA3y4kn2yybj9qJ1P33OErpgQv44sP7zHg8D2OvES4RpXm_77ohE4AikyBzxGdshcrkmZTw8zlbAYg50XDKzmLcw3zy4gU7FVKYXBqxYl-3fbfLRgot76ex6lvifc3vqG3icEehqXicwo7CkbuR-6auKVA3crejyJuOG-Q0NAca4pEPbmxSFl-yk9odIr16vM_Z96uP3zY32fbL9afNh21WKqnGrNTeSV05KAqU3pNQIjfeK9DeiLpEJyE3BbgKal9rKZSCgpx2WiIU6Iw8Z--WvkPo7yeKo01DV3Q4uI76KVrUGg0qLf4DTftABUZAQt_-he77KXTpIxbXOQo9LzpRsFBV6GMMVNshNK0LR4tgZzV2VmNnNXZRk0rePDaeypb8U8EfFwnIFqCJIz085S78smYt19re_tjYK2U-39xKZdeJv1j4st3_-_nfUPKklA</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Althausen, Anita</creator><creator>Gleissner, Ulrike</creator><creator>Hoppe, Christian</creator><creator>Sassen, Robert</creator><creator>Buddewig, Svenja</creator><creator>von Lehe, Marec</creator><creator>Schramm, Johannes</creator><creator>Elger, Christian Erich</creator><creator>Helmstaedter, Christoph</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>20130501</creationdate><title>Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients</title><author>Althausen, Anita ; Gleissner, Ulrike ; Hoppe, Christian ; Sassen, Robert ; Buddewig, Svenja ; von Lehe, Marec ; Schramm, Johannes ; Elger, Christian Erich ; Helmstaedter, Christoph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b434t-b5da35ca09913dde24286dd405d62fb1a308690ac0fdf5324409ea5a531091a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Age of Onset</topic><topic>Behavior</topic><topic>Brain - surgery</topic><topic>Cognition</topic><topic>Cognition - physiology</topic><topic>Cognition Disorders - etiology</topic><topic>Cognition Disorders - psychology</topic><topic>Convulsions & seizures</topic><topic>Encephalitis</topic><topic>Epilepsy</topic><topic>Epilepsy - surgery</topic><topic>Etiology</topic><topic>Expected values</topic><topic>Female</topic><topic>Hemispherectomy</topic><topic>Humans</topic><topic>Intelligence</topic><topic>Intelligence Tests</topic><topic>Male</topic><topic>Neuropsychology</topic><topic>Neurosurgery</topic><topic>Neurosurgical Procedures</topic><topic>Paediatric Neurosurgery</topic><topic>Patients</topic><topic>Postoperative Complications - psychology</topic><topic>Predictive Value of Tests</topic><topic>Questionnaires</topic><topic>Seizures - surgery</topic><topic>Social Behavior</topic><topic>Socioeconomic Factors</topic><topic>Surgery</topic><topic>Surveys and Questionnaires</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Althausen, Anita</creatorcontrib><creatorcontrib>Gleissner, Ulrike</creatorcontrib><creatorcontrib>Hoppe, Christian</creatorcontrib><creatorcontrib>Sassen, Robert</creatorcontrib><creatorcontrib>Buddewig, Svenja</creatorcontrib><creatorcontrib>von Lehe, Marec</creatorcontrib><creatorcontrib>Schramm, Johannes</creatorcontrib><creatorcontrib>Elger, Christian Erich</creatorcontrib><creatorcontrib>Helmstaedter, Christoph</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Althausen, Anita</au><au>Gleissner, Ulrike</au><au>Hoppe, Christian</au><au>Sassen, Robert</au><au>Buddewig, Svenja</au><au>von Lehe, Marec</au><au>Schramm, Johannes</au><au>Elger, Christian Erich</au><au>Helmstaedter, Christoph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients</atitle><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle><addtitle>J Neurol Neurosurg Psychiatry</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>84</volume><issue>5</issue><spage>529</spage><epage>536</epage><pages>529-536</pages><issn>0022-3050</issn><eissn>1468-330X</eissn><coden>JNNPAU</coden><abstract>Objective Hemispheric neurosurgery is an established treatment for severe epilepsy caused by extended unilateral brain pathology. However, it is still an unresolved question at which age surgery should best be performed. In light of decreasing plasticity and the cumulative impact of seizures and anticonvulsants on neurodevelopment, early surgery appears preferable. Methods We retrospectively investigated the medical, cognitive-behavioural and psychosocial long-term outcome (follow-up: 9.4 years (1.1–19.4)) of hemispherectomy as a function of age at surgery (early: <7 years/intermediate: 7–16 years/late: >16 years) based on a structured postal survey in a large patient sample (N=61/81, return rate: 75%). Results At follow-up, 45 (74%) patients were seizure free. Presurgical levels of intelligence were below average in most patients (79%) and postsurgical cognition largely resembled the presurgical capacities. Best seizure outcome was obtained for early surgery patients (90% seizure free). Patients with late surgery, however, exhibited higher presurgical and postsurgical intelligence and better psychosocial achievements. Binary logistic regression identified better presurgical intelligence and higher age at surgery as positive predictors of postsurgical intelligence. Lower presurgical intelligence and postsurgical seizure freedom predicted intellectual pre-post improvements. Conclusions Our data confirm the efficacy and cognitive safety of hemispheric surgeries performed at different ages. Eligible older and high functioning patients can be perfect candidates. Presurgical intelligence serves as indicator of the functional integrity of the contralateral hemisphere, which mainly determines postsurgical cognition and psychosocial outcome. Seizure freedom promotes cognitive improvement. As many unknown factors determined age at surgery, our retrospective data neither question early surgeries nor suggest postponing surgery.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>23268362</pmid><doi>10.1136/jnnp-2012-303811</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Adult Age Age Factors Age of Onset Behavior Brain - surgery Cognition Cognition - physiology Cognition Disorders - etiology Cognition Disorders - psychology Convulsions & seizures Encephalitis Epilepsy Epilepsy - surgery Etiology Expected values Female Hemispherectomy Humans Intelligence Intelligence Tests Male Neuropsychology Neurosurgery Neurosurgical Procedures Paediatric Neurosurgery Patients Postoperative Complications - psychology Predictive Value of Tests Questionnaires Seizures - surgery Social Behavior Socioeconomic Factors Surgery Surveys and Questionnaires Treatment Outcome Young Adult |
| title | Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients |
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