Brain Advance Access originally published online on July 7, 2004
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Brain, Vol. 127, No. 9, 2071-2079,
September 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh224
Functional consequences of hemispherectomy
1 Department of Paediatric Physical Therapy and Exercise Physiology, 2 Department of Neuropsychology, 3 Julius Centre for Health Sciences and Primary Care and 4 Department of Child Neurology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands on behalf of the Dutch Collaborative Epilepsy Surgery Programme
Correspondence to: R. van Empelen MA PT, Department of Paediatric Physical Therapy and Exercise Physiology, University Medical Centre, Wilhelmina Children's Hospital, RM. KB 02.056.0, P.O. Box 85090, 3508 AB Utrecht, The Netherlands E-mail: R.vanEmpelen{at}wkz.azu.nl
Using the International Classification of Functioning Disability and Health (ICF) (WHO, 2001), impairments, activities and social participation are reported in 12 children (mean age at surgery 5.9 years) who were investigated before and three times over a 2-year period after hemispherectomy. Impairments were assessed (i) in terms of seizure frequency (Engel classification) and seizure severity (HASS) and (ii) with respect to muscle strength (MRC), range of motion (JAM score) and muscle tone (modified Ashworth scale). Activities were assessed in terms of gross motor functioning (GMFM) and self-care, mobility and social function (PEDI). Participation was assessed in terms of epilepsy-related restrictions and quantified by means of the Hague Restrictions in Childhood Epilepsy Scale (HARCES). Nine out of 12 children could be classified as free of seizures (Engel class I), and in the remaining three seizure frequency was Engel class III. HASS scores showed maximum improvement in 10 out of 12 children and near-maximum improvement in the two remaining children. Muscle strength and muscle tone on the side of the body contralateral to the hemispherectomy, which were already decreased preoperatively, decreased even further in the first 6 months after surgery, but returned to the presurgical baseline thereafter, except for the distal part of the arm. Range of motion was abnormal prior to operation and remained so after operation. Mean GMFM increase was 20% after 2 years (95% confidence interval 10–33); all five dimensions improved statistically significantly (P < 0.05). Mean PEDI increase was more than 20 scale points (95% confidence interval 10–35); again, all domains improved significantly (P < 0.05). In nearly all children, HARCES scores had normalized 2 years after surgery. In conclusion, decrease of seizure frequency and severity widens the scope of motor and social functioning, which overrides the effects of remaining motor impairments.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  K. Malmgren, I. Olsson, E. Engman, R. Flink, and B. Rydenhag Seizure outcome after resective epilepsy surgery in patients with low IQ Brain, February 1, 2008; 131(2): 535 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. de Bode, G. W. Mathern, S. Bookheimer, and B. Dobkin Locomotor Training Remodels fMRI Sensorimotor Cortical Activations in Children After Cerebral Hemispherectomy Neurorehabil Neural Repair, December 1, 2007; 21(6): 497 - 508. [Abstract] [PDF]
|
|
|
|
|
|
R. van Empelen, A. Jennekens-Schinkel, J. W. Gorter, M. J. M. Volman, O. van Nieuwenhuizen, P. J. M. Helders, and on behalf of the Dutch Collaborative Epilepsy Surg Epilepsy surgery does not harm motor performance of children and adolescents Brain, July 1, 2005; 128(7): 1536 - 1545. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G. Bien, T. Granata, C. Antozzi, J. H. Cross, O. Dulac, M. Kurthen, H. Lassmann, R. Mantegazza, J.-G. Villemure, R. Spreafico, et al. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: A European consensus statement Brain, March 1, 2005; 128(3): 454 - 471. [Abstract] [Full Text] [PDF]
|
|