Brain Advance Access published online on July 7, 2004
Brain, doi:10.1093/brain/awh224
© 2004 by Guarantors of Brain
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1 Department of Paediatric Physical Therapy and Exercise Physiology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands on behalf of the Dutch Collaborative Epilepsy Surgery Programme
* To whom correspondence should be addressed. 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.
Revised April 28, 2004
Accepted April 30, 2004
Article
Functional consequences of hemispherectomy
2 Department of Neuropsychology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands on behalf of the Dutch Collaborative Epilepsy Surgery Programme
3 Julius Centre for Health Sciences and Primary Care, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands on behalf of the Dutch Collaborative Epilepsy Surgery Programme
4 Department of Paediatric Physical Therapy and Exercise Physiology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands on behalf of the Dutch Collaborative Epilepsy Surgery Programme;
5 Department of Child Neurology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands on behalf of the Dutch Collaborative Epilepsy Surgery Programme
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