Hemispherectomy for seizures

Rasmussen's Encephalitis

When the diagnosis of Rasmussen's encephalitis is being considered, it is important to rapidly exclude other causes of epilepsia partialis continua and hemiparesis. Although there is no good data from randomized trials of different immune-related therapies, treatment with immunoglobulin G (IgG), steroids, or plasmapheresis is advocated as first-line therapy. It is not unreasonable to institute at least two treatment options (eg, IgG followed by plasmapheresis) if response to the first treatment is poor. Functional hemispherectomy and its variants are associated with a lower long-term complication rate.

The effects of epilepsy surgery on the sensorimotor function of children

The motor and sensory functions of 50 children were investigated before and six months after epilepsy surgery; 34 infants were assessed 24 months after surgery. Postoperatively, 20 children were seizure-free and 22 had a significant reduction of seizures. Epilepsy surgery was found to be an effective mode of treatment for intractable seizures in childhood, even in multiply handicapped individuals. Motor and sensory functions did not deteriorate after surgery; in fact, significant improvements were found in more than half of the children, including those with multiple handicaps. Improvements were most obvious in the seizure-free group, but were also noted in those with reduced seizure frequency. The younger children benefited more from surgery as regards sensorimotor function than did older children and adolescents.

Grid implantation in seizure patients. A method to identify the epileptic focus

Patients with epilepsy face many medical and social obstacles. The fortunate ones have their seizures controlled by medication, enabling them to have a normal life-style. Others may benefit from grid implantation followed by excision of the seizure focus.