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Peli E, Jung JH. Review: Binocular double vision in the presence of visual field loss. J Vis 2024; 24:13. [PMID: 38899959 PMCID: PMC11193068 DOI: 10.1167/jov.24.6.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/13/2024] [Indexed: 06/21/2024] Open
Abstract
Binocular double vision in strabismus is marked by diplopia (seeing the same object in two different directions) and visual confusion (seeing two different objects in the same direction). In strabismus with full visual field, the diplopia coexists with visual confusion across most of the binocular field. With visual field loss, or with use of partial prism segments for field expansion, the two phenomena may be separable. This separability is the focus of this review and offers new insights into binocular function. We show that confusion is necessary but is not sufficient for field expansion. Diplopia plays no role in field expansion but is necessary for clinical testing of strabismus, making such testing difficult in field loss conditions with confusion without diplopia. The roles of the three-dimensional structure of the real world and the dynamic of eye movements within that structure are considered as well. Suppression of one eye's partial view under binocular vision that develops in early-onset (childhood) strabismus is assumed to be a sensory adaption to diplopia. This assumption can be tested using the separation of diplopia and confusion.
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Affiliation(s)
- Eli Peli
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jae-Hyun Jung
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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2
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Simmons C, Granovetter MC, Robert S, Liu TT, Patterson C, Behrmann M. Holistic processing and face expertise after pediatric resection of occipitotemporal cortex. Neuropsychologia 2024; 194:108789. [PMID: 38191121 PMCID: PMC10872222 DOI: 10.1016/j.neuropsychologia.2024.108789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
The nature and extent of hemispheric lateralization and its potential for reorganization continues to be debated, although there is general agreement that there is a right hemisphere (RH) advantage for face processing in human adults. Here, we examined face processing and its lateralization in individuals with a single preserved occipitotemporal cortex (OTC), either in the RH or left hemisphere (LH), following early childhood resection for the management of drug-resistant epilepsy. The matched controls and those with a lesion outside of OTC evinced the standard superiority in processing upright over inverted faces and the reverse sensitivity to a nonface category (bicycles). In contrast, the LH and the RH patient groups were significantly less accurate than the controls and showed mild orientation sensitivities at best (and not always in the predicted directions). For the two patient groups, the accuracies of face and bicycle processing did not differ from each other and were not obviously related to performance on intermediate level global form tasks with, again, poorer thresholds for both patient groups than controls and no difference between the patient groups. These findings shed light on the complexity of hemispheric lateralization and face and nonface object processing in individuals following surgical resection of OTC. Overall, this study highlights the unique dynamics and potential for plasticity in those with childhood cortical resection.
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Affiliation(s)
- Claire Simmons
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Michael C Granovetter
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Psychology and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, USA
| | - Sophia Robert
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, USA
| | - Tina T Liu
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, USA; Department of Neurology and Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Christina Patterson
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marlene Behrmann
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, USA; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA.
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Ayzenberg V, Granovetter MC, Robert S, Patterson C, Behrmann M. Differential functional reorganization of ventral and dorsal visual pathways following childhood hemispherectomy. Dev Cogn Neurosci 2023; 64:101323. [PMID: 37976921 PMCID: PMC10682827 DOI: 10.1016/j.dcn.2023.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/28/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
Hemispherectomy is a surgical procedure in which an entire hemisphere of a patient's brain is resected or functionally disconnected to manage seizures in individuals with drug-resistant epilepsy. Despite the extensive loss of both ventral and dorsal visual pathways in one hemisphere, pediatric patients who have undergone hemispherectomy show a remarkably high degree of perceptual function across many domains. In the current study, we sought to understand the extent to which functions of the ventral and dorsal visual pathways reorganize to the contralateral hemisphere following childhood hemispherectomy. To this end, we collected fMRI data from an equal number of left and right hemispherectomy patients who completed tasks that typically elicit lateralized responses from the ventral or the dorsal pathway, namely, word (left ventral), face (right ventral), tool (left dorsal), and global form (right dorsal) perception. Overall, there was greater evidence of functional reorganization in the ventral pathway than in the dorsal pathway. Importantly, because ventral and dorsal reorganization was tested within the very same patients, these results cannot be explained by idiosyncratic factors such as disease etiology, age at the time of surgery, or age at testing. These findings suggest that because the dorsal pathway may mature earlier, it may have a shorter developmental window of plasticity than the ventral pathway and, hence, be less malleable after perturbation.
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Affiliation(s)
- Vladislav Ayzenberg
- Department of Psychology, University of Pennsylvania, PA, USA; Department of Psychology and Neuroscience Institute, Carnegie Mellon University, PA, USA.
| | - Michael C Granovetter
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, PA, USA; School of Medicine, University of Pittsburgh, PA, USA
| | - Sophia Robert
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, PA, USA
| | - Christina Patterson
- School of Medicine, University of Pittsburgh, PA, USA; Department of Pediatrics, University of Pittsburgh, PA, USA
| | - Marlene Behrmann
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, PA, USA; Department of Pediatrics, University of Pittsburgh, PA, USA; Department of Ophthalmology, University of Pittsburgh, PA, USA.
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Pur DR, Sivakumar GK, Bursztyn LLCD, Iordanous Y, de Ribaupierre S. Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a systematic review. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00244-2. [PMID: 37640228 DOI: 10.1016/j.jcjo.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 06/09/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Children undergoing hemispheric surgery for intractable seizures are susceptible to visual complications including strabismus. This systematic review aims to investigate the rates and characteristics of strabismus development after hemispheric surgery and evaluate clinical implications for ophthalmologic care. METHODS A systematic search of MEDLINE, EMBASE, Cochrane, PsychINFO, and Web of Science databases was performed from database inception to May 2022. Included articles referred to strabismus outcomes in pediatric populations after hemispherectomy or hemispherotomy. Reviews and non-English-language publications were excluded. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Demographic data and characteristics of strabismus were extracted and tabulated. RESULTS Of 41 articles identified, 10 studies consisting of 384 pediatric participants (48% females) and age at surgery between 6 months and 16 years were included. Preoperative strabismus rates ranged between 3% and 56%, whereas postoperative rates ranged between 38% and 100%. With respect to the site of hemispheric surgery, contralateral exodeviation was the most common (16%-67%; n = 7) and then ipsilateral exodeviation (16%-56%; n = 2), whereas ipsilateral esodeviation was infrequent (4%-9%; n = 3). CONCLUSIONS Contralateral exotropia and ipsilateral esotropia may occur after hemispheric surgery and may have the potential to be field expanding. Concerns regarding negative social reactions should be balanced with the risk of visual field reduction and (or) diplopia by strabismus surgery. Higher-quality articles with large, homogeneous, and well-described populations (i.e., complete pre- and postoperative ophthalmologic assessments) are required to establish the risks and rates of strabismus development after hemispheric surgery.
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Affiliation(s)
- Daiana R Pur
- Schulich School of Medicine and Dentistry, Western University, London, ON.
| | - Gayathri K Sivakumar
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Lulu L C D Bursztyn
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Clinical Neurological Sciences, Western University, London, ON
| | - Yiannis Iordanous
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Sciences, Western University, London, ON; Brain and Mind Institute, Western University, London, ON; Children's Health Research Institute, Western University, London, ON
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Ayzenberg V, Granovetter MC, Robert S, Patterson C, Behrmann M. Differential functional reorganization of ventral and dorsal visual pathways following childhood hemispherectomy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.03.551494. [PMID: 37577633 PMCID: PMC10418255 DOI: 10.1101/2023.08.03.551494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Hemispherectomy is a surgical procedure in which an entire hemisphere of a patient's brain is resected or functionally disconnected to manage seizures in individuals with drug-resistant epilepsy. Despite the extensive loss of input from both ventral and dorsal visual pathways of one hemisphere, pediatric patients who have undergone hemispherectomy show a remarkably high degree of perceptual function across many domains. In the current study, we sought to understand the extent to which functions of the ventral and dorsal visual pathways reorganize to the contralateral hemisphere following childhood hemispherectomy. To this end, we collected fMRI data from an equal number of left and right hemispherectomy patients who completed tasks that typically elicit lateralized responses from the ventral or the dorsal pathway, namely, word (left ventral), face (right ventral), tool (left dorsal), and global form (right dorsal) perception. Overall, there was greater evidence of functional reorganization in the ventral pathway than in the dorsal pathway. Importantly, because ventral and dorsal reorganization was tested in the very same patients, these results cannot be explained by idiosyncratic factors such as disease etiology, age at the time of surgery, or age at testing. These findings suggest that because the dorsal pathway may mature earlier, it may have a shorter developmental window of plasticity than the ventral pathway and, hence, be less malleable.
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Affiliation(s)
- Vladislav Ayzenberg
- Department of Psychology, University of Pennsylvania
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University
| | - Michael C Granovetter
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University
- School of Medicine, University of Pittsburgh
| | - Sophia Robert
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University
| | - Christina Patterson
- School of Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
| | - Marlene Behrmann
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University
- Department of Pediatrics, University of Pittsburgh
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Dichoptic visual field mapping of suppression in exotropia with homonymous hemianopia. J AAPOS 2021; 25:276.e1-276.e6. [PMID: 34587558 PMCID: PMC8665098 DOI: 10.1016/j.jaapos.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to investigate which portions of the visual scene are perceived by each eye in an exotropic subject with acquired hemianopia. The pattern of suppression is predictable from knowledge of how suppression scotomas are organized in exotropic subjects with intact visual fields. METHODS Dichoptic perimetry was performed by having a subject wear red/blue goggles while fixating a cross that was either red or blue. Red, blue, or purple spots were presented briefly at peripheral locations. The subject's identification of the spot color revealed which eye was perceptually engaged at any given location in the visual fields. RESULTS A 17-year-old female with a history of exotropia was evaluated after rupture of a right parietal arteriovenous malformation. Dichoptic perimetry showed a left homonymous hemianopia. All stimuli to the right of the right fovea's projection point were perceived via the right eye. Stimuli between the foveal projection points, which were separated horizontally by the 20° exotropia, were perceived by the left eye. CONCLUSIONS Perception of the visual scene is shared by the eyes in hemianopia and exotropia. Suppression occurs only in the peripheral temporal retina of the eye contralateral to the brain lesion, regardless of which eye is engaged in fixation. Although exotropia expands the binocular field of vision in hemianopia, it is probably not an adaptive response, even when it develops after hemianopia.
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Christodoulou JA, Halverson K, Meegoda O, Beckius H, Moser S, Imhof A, Maguire A. Literacy-related skills among children after left or right hemispherectomy. Epilepsy Behav 2021; 121:107995. [PMID: 34004523 DOI: 10.1016/j.yebeh.2021.107995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Following hemispherectomy surgery, children's educational outcomes are of great importance but are understudied. The study goal was to investigate reading, language, and nonverbal cognitive skills in children obligatorily relying on a left versus right hemisphere using a cross-sectional design. METHODS Participants (ages 6-18) who had undergone left hemispherectomy (LH; n = 10) or right hemispherectomy (RH; n = 14) completed standardized measures of reading, language, and nonverbal cognition. RESULTS LH and RH groups were balanced for socioeconomic status, sex, and age. Both groups scored below the population mean across standardized measures (RH: -0.79 to -1.95 SDs; LH: -0.97 to -2.32 SDs). Compared to the LH group, the group retaining a functional left hemisphere (RH group) learned to read sooner (p = .011) despite no significant differences for surgery age, and scored higher on untimed real word and pseudoword reading measures (p < .05). Effect sizes were medium (r = 0.34-0.46) for the LH and RH comparison on measures of phonological awareness and both untimed and timed word and pseudoword reading. In examining the association between clinical variables and reading-related outcomes, younger age of post-hemispherectomy reading acquisition and shorter duration between seizure onset and hemispherectomy surgery were associated with higher standardized reading and language test scores (p < .05). SIGNIFICANCE Investigations of psychoeducational skills in reading, language, and nonverbal cognition among children who have undergone hemispherectomy can offer important insights into compensatory potential for left and right hemispheres as well as inform educational programming for children following medical stabilization.
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Affiliation(s)
- Joanna A Christodoulou
- MGH Institute of Health Professions (MGH IHP), Department of Communication Sciences and Disorders, 36 First Avenue, Boston, MA 02129, USA.
| | - Kelly Halverson
- MGH Institute of Health Professions (MGH IHP), Department of Communication Sciences and Disorders, 36 First Avenue, Boston, MA 02129, USA; University of Houston, Department of Psychology, 3695 Cullen Boulevard, Houston, TX 77204, USA
| | - Olivia Meegoda
- MGH Institute of Health Professions (MGH IHP), Department of Communication Sciences and Disorders, 36 First Avenue, Boston, MA 02129, USA
| | - Heather Beckius
- MGH Institute of Health Professions (MGH IHP), Department of Communication Sciences and Disorders, 36 First Avenue, Boston, MA 02129, USA
| | - Sarah Moser
- MGH Institute of Health Professions (MGH IHP), Department of Communication Sciences and Disorders, 36 First Avenue, Boston, MA 02129, USA
| | - Andrea Imhof
- MGH Institute of Health Professions (MGH IHP), Department of Communication Sciences and Disorders, 36 First Avenue, Boston, MA 02129, USA
| | - Amy Maguire
- MGH Institute of Health Professions (MGH IHP), Department of Communication Sciences and Disorders, 36 First Avenue, Boston, MA 02129, USA
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Meer EA, Chen MF, Jones M, Mathern GW, Pineles SL. Long-Term Patient-Reported Outcomes of Visual Field Defects and Compensatory Mechanisms in Patients After Cerebral Hemispherectomy. J Neuroophthalmol 2021; 41:147-153. [PMID: 32701758 DOI: 10.1097/wno.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In cases of intractable epilepsy resistant to drug therapy, hemispherectomy is often the only treatment option to mitigate seizures; however, the true long-term subjective visual outcomes are relatively unexplored. In this study, we sought to determine and characterize patient-reported visual function years after hemispherectomy. METHODS This was an observational study conducted on a large cohort of children with seizure disorder treated with cerebral hemispherectomy. An online survey was sent to parents with questions to assess subjective visual function with a variety of questions from presence of visual field defects after hemispherectomy, to improvement over time, compensatory mechanisms used, and development of strabismus. RESULTS This survey was emailed to 248 parents of previously evaluated children who agreed to be re-surveyed, 48 (20%) of which responded. The average age at hemispherectomy was approximately 5 (±4) years, and the average time after hemispherectomy was 7 (±5) years. Thirty-nine patients (81%) were seizure-free after 1 surgery and 85% (n = 41) were seizure-free after ≥1 surgeries. Thirty-four (71%) experienced a visual field defect after surgery, but 25 (52%) experienced subjective improvement over time. Thirty-eight (79%) used compensatory mechanisms, such as head tilting, with 16 (33%) patients experiencing subjective improvement over time. Twenty-seven (56%) patients experienced a decrease in visual acuity after surgery with 12 (25%) experiencing subjective improvement over time. CONCLUSION In a large cohort examining patient-reported visual outcomes years after hemispherectomy, most patients experienced strabismus and/or visual field defects. However, more than half reported improvements and compensatory mechanisms (exotropic strabismus and ipsilateral esotropic strabismus) over time, presumably to enhance visual field function. By exploring subjective visual and cognitive function, this paper uniquely characterizes patient-reported improvements over time, and provides motivation for larger longitudinal studies using more quantitative measures of visual function and improvement after hemispherectomy.
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Affiliation(s)
- Elana A Meer
- Perelman School of Medicine (EAM), University of Pennsylvania, Philadelphia, Pennsylvania; University of California Los Angeles School of Medicine (MFC), Los Angeles, California; CEO (MJ), Brain Recovery Project Childhood Epilepsy Surgery Foundation, Los Angeles, California; Brain Research Institute (GWM), University of California Los Angeles School of Medicine, Los Angeles, California; Neurological Surgery and Pediatric Neurological Surgery (GWM), Santa Monica UCLA Medical Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; and Department of Ophthalmology (SLP), Stein Eye Institute, University of California Los Angeles, California
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Waddington J, Pickering JS, Hodgson T. The Table-top Visual Search Ability Test for children and young people: Normative response time data from typically developing children. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2021. [DOI: 10.1177/0264619620915258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Five table-top tasks were developed to test the visual search ability of children and young people in a real-world context, and to assess the transfer of training-related improvements in visual search on computerised tasks to real-world activities. Each task involved searching for a set of target objects among distracting objects on a table-top. Performance on the Table-top Visual Search Ability Test for Children (TVSAT-C) was measured as the time spent searching for targets divided by the number of targets found. A total of 108 typically developing children (3–11 years old) and eight children with vision impairment (7–12 years old) participated in the study. A significant correlation was found between log-transformed age and log-transformed performance ( R2 = .65, p = 4 × 10−26) in our normative sample, indicating a monomial power law relationship between age and performance with an exponent of [Formula: see text], [Formula: see text] We calculated age-dependent percentiles and receiver operating characteristic curve analysis indicated the third percentile as the optimal cut-off for detecting a visual search deficit, giving a specificity of [Formula: see text], [Formula: see text] and sensitivity of [Formula: see text], [Formula: see text] for the test. Further studies are required to calculate measures of reliability and external validity, to confirm sensitivity for visual search deficits, and to investigate the most appropriate response modes for participants with conditions that affect manual dexterity. In addition, more work is needed to assess construct validity where semantic knowledge is required that younger children may not have experience with. We have made the protocol and age-dependent normative data available for those interested in using the test in research or practice, and to illustrate the smooth developmental trajectory of visual search ability during childhood.
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Weil AG, Lewis EC, Ibrahim GM, Kola O, Tseng CH, Zhou X, Lin KM, Cai LX, Liu QZ, Lin JL, Zhou WJ, Mathern GW, Smyth MD, O'Neill BR, Dudley R, Ragheb J, Bhatia S, Delev D, Ramantani G, Zentner J, Ojemann J, Wang AC, Dorfer C, Feucht M, Czech T, Bollo RJ, Issabekov G, Zhu H, Connelly M, Steinbok P, Zhang JG, Zhang K, Hidalgo ET, Weiner HL, Wong-Kisiel L, Lapalme-Remis S, Tripathi M, Sarat Chandra P, Hader W, Wang FP, Yao Y, Olivier Champagne P, Guo Q, Li SC, Budke M, Pérez-Jiménez MA, Raftapoulos C, Finet P, Michel P, Schaller K, Stienen MN, Baro V, Cantillano Malone C, Pociecha J, Chamorro N, Muro VL, von Lehe M, Vieker S, Oluigbo C, Gaillard WD, Al Khateeb M, Al Otaibi F, Krayenbühl N, Bolton J, Pearl PL, Fallah A. Hemispherectomy Outcome Prediction Scale: Development and validation of a seizure freedom prediction tool. Epilepsia 2021; 62:1064-1073. [PMID: 33713438 DOI: 10.1111/epi.16861] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop and validate a model to predict seizure freedom in children undergoing cerebral hemispheric surgery for the treatment of drug-resistant epilepsy. METHODS We analyzed 1267 hemispheric surgeries performed in pediatric participants across 32 centers and 12 countries to identify predictors of seizure freedom at 3 months after surgery. A multivariate logistic regression model was developed based on 70% of the dataset (training set) and validated on 30% of the dataset (validation set). Missing data were handled using multiple imputation techniques. RESULTS Overall, 817 of 1237 (66%) hemispheric surgeries led to seizure freedom (median follow-up = 24 months), and 1050 of 1237 (85%) were seizure-free at 12 months after surgery. A simple regression model containing age at seizure onset, presence of generalized seizure semiology, presence of contralateral 18-fluoro-2-deoxyglucose-positron emission tomography hypometabolism, etiologic substrate, and previous nonhemispheric resective surgery is predictive of seizure freedom (area under the curve = .72). A Hemispheric Surgery Outcome Prediction Scale (HOPS) score was devised that can be used to predict seizure freedom. SIGNIFICANCE Children most likely to benefit from hemispheric surgery can be selected and counseled through the implementation of a scale derived from a multiple regression model. Importantly, children who are unlikely to experience seizure control can be spared from the complications and deficits associated with this surgery. The HOPS score is likely to help physicians in clinical decision-making.
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Affiliation(s)
- Alexander G Weil
- Department of Neurosurgery, Saint Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Evan C Lewis
- Neurology Centre of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Pediatric Neurosurgery, Sick Kids Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Kola
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Xinkai Zhou
- Department of Biostatistics, Fielding School of Public Health at, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kao-Min Lin
- Department of Functional Neurosurgery, Xiamen Humanity Hospital, Xiamen, China
| | - Li-Xin Cai
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Qing-Zhu Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Jiu-Luan Lin
- Department of Epilepsy Center, Yuquan Hospital, Tsinghua University, Beijing, China
| | - Wen-Jing Zhou
- Department of Epilepsy Center, Yuquan Hospital, Tsinghua University, Beijing, China
| | - Gary W Mathern
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Matthew D Smyth
- Department of Neurological Surgery, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Brent R O'Neill
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Roy Dudley
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - John Ragheb
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Sanjiv Bhatia
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Daniel Delev
- Department of Neurosurgery, University Medical Center Freiburg and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Georgia Ramantani
- Department of Neurosurgery, University Medical Center Freiburg and Medical Faculty, University of Freiburg, Freiburg, Germany.,Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Josef Zentner
- Department of Neurosurgery, University Medical Center Freiburg and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jeffrey Ojemann
- Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Anthony C Wang
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Martha Feucht
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Robert J Bollo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Galymzhan Issabekov
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongwei Zhu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mary Connelly
- Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Steinbok
- Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Eveline Teresa Hidalgo
- Division of Pediatric Neurosurgery, Department of Surgery, Hassenfeld Children's Hospital, NYU Langone Health, New York, New York, USA
| | - Howard L Weiner
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lily Wong-Kisiel
- Division of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Samuel Lapalme-Remis
- Division of Neurology, Department of Medicine, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences and National Brain Research Center, New Delhi, India
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery (Center of Excellence for Epilepsy & Magnetoencephalography), All India Institute of Medical Sciences and National Brain Research Center, New Delhi, India
| | - Walter Hader
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Feng-Peng Wang
- Department of Functional Neurosurgery, Xiamen Humanity Hospital, Xiamen, China
| | - Yi Yao
- Division of Epilepsy Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | | | - Qiang Guo
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou Shi, China
| | - Shao-Chun Li
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou Shi, China
| | - Marcelo Budke
- Department of Neurosurgery, Niño Jesus University Children's Hospital, Madrid, Spain
| | | | - Christian Raftapoulos
- Department of Neurosurgery, Brussels Saint-Luc University Hospital, Brussels, Belgium
| | - Patrice Finet
- Department of Neurosurgery, Brussels Saint-Luc University Hospital, Brussels, Belgium
| | - Pauline Michel
- Department of Neurosurgery, Brussels Saint-Luc University Hospital, Brussels, Belgium
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Zurich University Hospital and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Valentina Baro
- Academic Neurosurgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Christian Cantillano Malone
- Department of Neurosurgery, Pontifical Catholic University of Chile, Sotero del Rio Hospital, Santiago, Chile
| | - Juan Pociecha
- Epilepsy Department, Fleni Epilepsy Neurology and Neurophysiology Service, Buenos Aires, Argentina
| | - Noelia Chamorro
- Epilepsy Department, Fleni Epilepsy Neurology and Neurophysiology Service, Buenos Aires, Argentina
| | - Valeria L Muro
- Epilepsy Department, Fleni Epilepsy Neurology and Neurophysiology Service, Buenos Aires, Argentina
| | - Marec von Lehe
- Department of Neurosurgery, University Hospital Bochum, Bochum, Germany.,Department of Neurosurgery, Brandenburg Medical School, Neuruppin, Germany
| | - Silvia Vieker
- Department of Neurosurgery, University Hospital Bochum, Bochum, Germany.,Department of Neurosurgery, Brandenburg Medical School, Neuruppin, Germany
| | - Chima Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA
| | - William D Gaillard
- Divisions of Child Neurology and Epilepsy and Neurophysiology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Mashael Al Khateeb
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
| | - Faisal Al Otaibi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Zurich University Hospital and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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11
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Neumayr L, Gschaidmeier A, Trauzettel-Klosinski S, Pieper T, Kudernatsch M, Hofer W, Bajer C, Staudt M. Gesichtsfelddefekte vor und nach pädiatrischer Epilepsiechirurgie. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021; 34:49-56. [DOI: 10.1007/s10309-020-00379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 08/30/2023]
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12
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Neumayr L, Gschaidmeier A, Trauzettel-Klosinski S, Pieper T, Kudernatsch M, Hofer W, Bajer C, Staudt M. Sacrificing one visual hemifield during pediatric epilepsy surgery: Effects on visual search. Eur J Paediatr Neurol 2020; 29:103-107. [PMID: 32988735 DOI: 10.1016/j.ejpn.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/23/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate early and late effects of planned surgically acquired homonymous hemianopias on visual search in children and adolescents. METHODS This prospective study included five patients (5y 5 m-18y 0 m; 2 girls) with pharmaco-refractory epilepsies in whom one visual hemifield was sacrificed as part of the surgical strategy, and, as controls, seven patients (5y 11 m-18y 0 m; 6 girls) undergoing epilepsy surgeries not affecting the visual fields. Visual search was studied using the "Table Test", which is an everyday life-like visual search test. General processing speed was studied using a standard IQ subtest. RESULTS All five patients with newly acquired homonymous hemianopias showed a relative disadvantage of visual search times for objects in their newly blind hemifields immediately after the surgery. Six months later, this relative disadvantage had recovered completely in all patients. Nevertheless, compared with the preoperative situation, overall search times were still prolonged in the hemianopic patients, but this effect could be mitigated or even overcompensated by improvements in processing speed. CONCLUSIONS Children with homonymous hemianopias inflicted by epilepsy surgery develop effective compensation strategies to minimize the relative disadvantage of visual search in their blind hemifields. For changes in overall visual search times between the preoperative and the six-month follow-up examination, we could demonstrate overlapping effects of (a) deterioration by hemianopia and (b) amelioration by improved processing speed as part of the cognitive improvements achieved by amelioration of the epilepsy.
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Affiliation(s)
- Lisa Neumayr
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Vogtareuth, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
| | - Alisa Gschaidmeier
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Vogtareuth, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | | | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Vogtareuth, Germany; Research Institute "Rehabilitation, Transition, Palliation" PMU Salzburg, Salzburg, Austria
| | - Wiebke Hofer
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Vogtareuth, Germany
| | - Christina Bajer
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Vogtareuth, Germany
| | - Martin Staudt
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Vogtareuth, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
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13
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Neumayr L, Pieper T, Kudernatsch M, Trauzettel-Klosinski S, Staudt M. Uncovering homonymous visual field defects in candidates for pediatric epilepsy surgery. Eur J Paediatr Neurol 2020; 25:165-171. [PMID: 31784289 DOI: 10.1016/j.ejpn.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/03/2019] [Accepted: 11/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Perimetry in children can be challenging due to low cooperation and short attention span. Especially during the pre-surgical work-up of children with pharmaco-refractory epilepsies, however, diagnosing homonymous visual field defects (HVFDs) can be crucial for planning surgical strategies. Here, we evaluated "campimetry" for visual field testing in children. Furthermore, we analyzed strabismus and anomalous head posture as clinical signs for HVFDs. METHODS Campimetry and a standard orthoptic examination were performed in 18 patients (age range: 3 y 2 m-18 y) who underwent epilepsy surgeries in our center during the study period, and in 11 additional patients (age range: 2 y 10 m-22 y 10 m) with suspected or confirmed HVFDs. RESULTS In 16/18 patients of our unselected surgery cohort, pre- and postoperative campimetry was successfully completed. Of these, only 7/16 patients had intact visual fields pre- and postoperatively, while 5/16 patients already showed preoperative HVFDs and 4/16 patients suffered newly acquired HVFDs as calculated consequences of the surgery. Regarding clinical signs, strabismus (mostly esotropia) and anomalous head posture were specific indicators of HVFDs (strabismus: 6/12 with HVFDs vs 1/18 without; anomalous head posture: 8/12 with HVFDs vs 0/18 without). CONCLUSIONS For perimetry in children with limited cooperation, we suggest campimetry as it allows early detection and fast delineation of HVFDs. This is particularly important in pediatric epilepsy surgery patients, who display a surprisingly high proportion of HVFDs (9/16). Both, strabismus and anomalous head posture can indicate such HVFDs. Therefore, clinicians should pay attention to these clinical signs, especially in the context of epilepsy surgery.
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Affiliation(s)
- Lisa Neumayr
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
| | - Tom Pieper
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany; Research Institute "Rehabilitation, Transition, Palliation" PMU Salzburg, Salzburg, Austria
| | | | - Martin Staudt
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
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14
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Hemispherotomy can cause post-operative strabismus. Brain Dev 2020; 42:41-47. [PMID: 31521421 DOI: 10.1016/j.braindev.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hemispherotomy, which involves disconnecting hemispherical fibers, is a treatment option for medically intractable epilepsy. As various neurological disorders can cause strabismus, we hypothesized that hemispherotomy can cause post-operative strabismus in patients with medically intractable epilepsy. METHODS Nineteen patients underwent the Hirschberg test before and after hemispherical disconnection surgery. Among the 19 patients, 16 patients (six females and 10 males; mean age, 12.2 years; range, 0.17-43 years) who underwent hemispherotomy were included in this study. RESULTS The difference in the angle between the left and right eyes was significantly widened (p = 0.025). Nine (56%) of 16 patients exhibited post-operative chronic strabismus as evaluated with the Hirschberg test. Intermittent strabismus was noticed by family members or caregivers in 10 (63%) of 16 patients. Patients older than 12 years did not show post-operative strabismus as evaluated by the Hirschberg test. CONCLUSION Hemispherotomy can cause or worsen post-operative strabismus in pediatric patients.
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15
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Chen MF, Meer E, Velez FG, Jones M, Mathern GW, Pineles SL. Etiology and Age Modifies Subjective Visual Function After Cerebral Hemispherectomy. J Child Neurol 2019; 34:446-451. [PMID: 30957613 DOI: 10.1177/0883073819834430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral hemispherectomy is typically used to treat patients with pharmacoresistant epilepsy. Visual-related outcomes are relatively unstudied in this population, aside from the knowledge that patients develop a complete homonymous hemianopia contralateral to the side of the hemispherectomy. The purpose of this study was to determine and characterize parent-reported functional visual, oculomotor, and postural changes in a large population of patients following cerebral hemispherectomy. METHODS An online survey was sent to parents of children who had undergone hemispherectomy for seizure control. Families were recruited by the Brain Recovery Project: Childhood Epilepsy Surgery Foundation. Parent-reported subjective visual function was assessed by the presence of peripheral field defects, ocular misalignment and anomalous head posture. RESULTS A total of 196 (12.5%) participants responded. Postoperative follow-up was 92±78 months (range: 1-382). Ninety-three percent of parents reported the child had difficulties with peripheral vision. Torticollis was present postoperatively in 122 (62%) patients. Strabismus was noted in 93 (49%). Fifty-five (59%) of the strabismus patients demonstrated exotropia with the majority of exotropia patients demonstrating the exo-deviated eye in the direction contralateral to the hemispherectomy (74.5%). Both torticollis and strabismus were most frequently seen immediately after surgery. Sixty-six patients (34%) underwent strabismus treatment. Patients with younger age of seizure onset, younger age of surgery, and certain epilepsy etiologies (hemimegencephaly, Sturge-Weber syndrome) were more likely to develop strabismus and torticollis. CONCLUSIONS Torticollis and strabismus are common after hemispherectomy and appear to be influenced by etiology and age at surgery. Preoperative discussion with parents and patients regarding those compensatory mechanisms is recommended, and postoperative ophthalmologic assessments are also encouraged.
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Affiliation(s)
- Monica F Chen
- 1 Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA
| | - Elana Meer
- 1 Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA
| | - Federico G Velez
- 1 Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA.,3 Olive View UCLA Medical Center, Sylmar, CA, USA
| | - Monika Jones
- 4 The Brain Recovery Project: Childhood Epilepsy Surgery Foundation, Pasadena, CA, USA
| | - Gary W Mathern
- 5 Departments of Neurosurgery and Psychiatry & Biobehavioral Medicine David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Stacy L Pineles
- 1 Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA
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Cossu G, Messerer M, Daniel RT. Letter: Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurosurgery 2019; 84:E448. [PMID: 30968133 DOI: 10.1093/neuros/nyz065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Giulia Cossu
- Department of Neurosurgery University Hospital of Lausanne Canton de Vaud, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery University Hospital of Lausanne Canton de Vaud, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery University Hospital of Lausanne Canton de Vaud, Switzerland
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Bronstad PM, Peli E, Liu R, Doherty A, Fulton AB. High prevalence of strabismic visual field expansion in pediatric homonymous hemianopia. PLoS One 2018; 13:e0209213. [PMID: 30566507 PMCID: PMC6300329 DOI: 10.1371/journal.pone.0209213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022] Open
Abstract
If homonymous hemianopia develops in childhood it is frequently accompanied by strabismus. In some of these cases the strabismus increases the size of the binocular visual field. We determined how prevalent visual-field-expanding strabismus is in children who have homonymous hemianopia. Medical records were examined from 103 hemianopic patients with exotropia (XT) or esotropia (ET). For each participant, we determined whether their strabismus was in a direction that resulted in visual field expansion (i.e. left exotropia with left homonymous hemianopia). Ages at which hemianopia and strabismus were first noted were compared to determine which developed first. The prevalence of XT (24%) and ET (9%) with homonymous hemianopia were both much higher than in the general population (1.5% and 5%, respectively). More strabismic eyes pointed to the blind than seeing side (62 vs 41, 60% vs. 40%, p = 0.02). Exotropic eyes were five times more likely to point to the blind side than esotropic eyes (85% vs 15%). Strabismus, especially exotropia, is much more common in pediatric homonymous hemianopia than in the general population. The strabismus is significantly more often in a visual field-expanding direction. These results support an adaptive role for the strabismus. Patients with HH and exotropia or esotropia should be aware that their visual field could be reduced by strabismus surgery.
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Affiliation(s)
- P. Matthew Bronstad
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Eli Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rui Liu
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Amy Doherty
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
| | - Anne B. Fulton
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
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Ivanov IV, Kuester S, MacKeben M, Krumm A, Haaga M, Staudt M, Cordey A, Gehrlich C, Martus P, Trauzettel-Klosinski S. Effects of visual search training in children with hemianopia. PLoS One 2018; 13:e0197285. [PMID: 30020930 PMCID: PMC6051578 DOI: 10.1371/journal.pone.0197285] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/27/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study investigates the effect of a new computer-based visual search training (VST) that was adapted for children with homonymous hemianopia (HH). METHODS 22 children with HH (median age 11 years, 8 months: 6y6m-19y2m) trained at home for 15 minutes twice/day, 5 days/week, for 6 weeks. To assess performance before training (T1), directly after training (T2) and 6 weeks after the end of training (T3), we measured search times (STs) during on-screen search (with eye tracking), and in a real life search task. Additional variables analyzed during on-screen search were numbers, amplitudes, and durations of saccades, their directional patterns and the proportional number of saccades into the non-seeing field. The latter was the main variable during free viewing. Sixteen healthy age-matched children, who did not undergo the training, served as comparison group. Quality of Life (QoL)-questionnaires were also applied. RESULTS STs of the patients decreased significantly during the training and all search performance tests. This improvement persisted 6 weeks after the end of the training. Saccade amplitudes increased, total number of saccades to find the target decreased, and the proportional number of saccades to the non-seeing side increased. These changes were maintained at T3. Saccade durations did not change. During free viewing, saccades were equally distributed to both sides before and after training. Patients reported improvements in QoL and activities of daily living. Performance in the healthy children did not change by simply repeating the visual search test. CONCLUSIONS The improvement in STs in all search tasks, larger and fewer saccades, and an improved search strategy after VST suggests that the children with HH benefited from the training. The maintained improvement at T3 and the improvement in the real life search task indicate that the newly developed search strategy persists and can be applied to everyday life.
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Affiliation(s)
- Iliya V. Ivanov
- Vision Rehabilitation Research Unit, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
- ZEISS Vision Science Lab, Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Stephan Kuester
- Vision Rehabilitation Research Unit, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Manfred MacKeben
- The Smith-Kettlewell Eye Research Institute, San Francisco, California, United States of America
| | - Anna Krumm
- Vision Rehabilitation Research Unit, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Manja Haaga
- Pediatric Neurology, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Martin Staudt
- Pediatric Neurology, University Children’s Hospital Tübingen, Tübingen, Germany
- Schön Klinik Vogtareuth, Clinic for Neuropediatrics and Neurorehabilitation, Vogtareuth, Germany
| | - Angelika Cordey
- Vision Rehabilitation Research Unit, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Claudia Gehrlich
- Vision Rehabilitation Research Unit, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
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Abstract
Much remains to be understood about visual system malfunction following injury. The resulting deficits range from dense, visual field scotomas to mild dysfunction of visual perception. Despite the predictive value of anatomical localization studies, much patient-to-patient variability remains regarding (a) perceptual abilities following injury and (b) the capacity of individual patients for visual rehabilitation. Visual field perimetry is used to characterize the visual field deficits that result from visual system injury. However, standard perimetry mapping does not always precisely correspond to underlying anatomical or functional deficits. Functional magnetic resonance imaging can be used to probe the function of surviving visual circuits, allowing us to classify better how the pattern of injury relates to residual visual perception. Identifying pathways that are potentially modifiable by training may guide the development of improved strategies for visual rehabilitation. This review discusses primary visual cortex lesions, which cause dense contralateral scotomas.
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Affiliation(s)
- Stelios M Smirnakis
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts 02115.,Department of Neurology, Jamaica Plain Campus, Veterans Administration Boston Healthcare System, Boston, Massachusetts 02130.,Harvard Medical School, Boston, Massachusetts 02115;
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Review of rehabilitation and habilitation strategies for children and young people with homonymous visual field loss caused by cerebral vision impairment. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2017. [DOI: 10.1177/0264619617706100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Partial and homonymous visual field loss (HVFL) is a common consequence of post-chiasmatic injury to the primary visual pathway or injury to the primary visual cortex. Different approaches to rehabilitation have been reported for older adults with HVFL and there is evidence to support the use of compensatory training over other proposed therapies. We reviewed the literature to investigate the current state of the art of rehabilitation and habilitation strategies for children and young people with HVFL, and whether there is enough evidence to support the use of these strategies in the paediatric population. We have provided an overview of the existing literature on children and young people with HVFL, a brief overview of rehabilitation strategies for adults with HVFL, and evidence on whether these different interventions have been applied with children and young people effectively. We found that there have been very few studies to investigate these strategies with children and young people, and the quality of evidence is currently low. New research is required to evaluate which strategies are effective for children and young people with HVFL and whether new strategies need to be developed.
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Handley SE, Vargha-Khadem F, Bowman RJ, Liasis A. Visual Function 20 Years After Childhood Hemispherectomy for Intractable Epilepsy. Am J Ophthalmol 2017; 177:81-89. [PMID: 28237414 DOI: 10.1016/j.ajo.2017.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/10/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate visual function in adults post hemispherectomy in childhood. DESIGN Noncomparative case series. METHODS All participants underwent visual acuity, binocular function, visual field, optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and monocular pattern reversal visually evoked potentials (prVEP). PARTICIPANTS Six adults who had a hemispherectomy in childhood (median 21.5 years postoperative). MAIN OUTCOME MEASURES Comparison was made of visual acuity, visual field height, global RNFL thickness, and prVEP amplitude evoked by full- and half-field stimulation. Comparison of the eye ipsilateral to the side of surgery to the contralateral eye was achieved employing paired t tests to the visual function measures. RESULTS All participants had homonymous hemianopia. The residual seeing visual field was constricted in all cases when compared with normative data despite crossing the midline into the blind hemifield in 11 of 12 eyes. This observation was supported by prVEP to stimuli presented in the blind half field. The height of the visual field was smaller in the eye contralateral to the side of surgery compared with the ipsilateral side (P = .047). Visual acuity and RNFL thickness also showed greater diminution in the contralateral eye (P = .040 and P = .0004). Divergent strabismus was found in 4 participants with greater field loss. CONCLUSIONS Adults post hemispherectomy in childhood may have better visual function in the eye ipsilateral to the side of the hemispherectomy compared with the contralateral eye. Possible mechanisms of the interocular difference are discussed. Though visual fields and prVEP responses demonstrate evidence of reorganization into the blind half field, they also reveal significant unexpected constriction of the functional field.
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Tailor V, Glaze S, Unwin H, Bowman R, Thompson G, Dahlmann-Noor A. Saccadic vector optokinetic perimetry in children with neurodisability or isolated visual pathway lesions: observational cohort study. Br J Ophthalmol 2016; 100:1427-32. [PMID: 26740608 DOI: 10.1136/bjophthalmol-2015-307208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/12/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Children and adults with neurological impairments are often not able to access conventional perimetry; however, information about the visual field is valuable. A new technology, saccadic vector optokinetic perimetry (SVOP), may have improved accessibility, but its accuracy has not been evaluated. We aimed to explore accessibility, testability and accuracy of SVOP in children with neurodisability or isolated visual pathway deficits. METHODS Cohort study; recruitment October 2013-May 2014, at children's eye clinics at a tertiary referral centre and a regional Child Development Centre; full orthoptic assessment, SVOP (central 30° of the visual field) and confrontation visual fields (CVF). Group 1: age 1-16 years, neurodisability (n=16), group 2: age 10-16 years, confirmed or suspected visual field defect (n=21); group 2 also completed Goldmann visual field testing (GVFT). RESULTS Group 1: testability with a full 40-point test protocol is 12.5%; with reduced test protocols, testability is 100%, but plots may be clinically meaningless. Children (44%) and parents/carers (62.5%) find the test easy. SVOP and CVF agree in 50%. Group 2: testability is 62% for the 40-point protocol, and 90.5% for reduced protocols. Corneal changes in childhood glaucoma interfere with SVOP testing. All children and parents/carers find SVOP easy. Overall agreement with GVFT is 64.7%. CONCLUSIONS While SVOP is highly accessible to children, many cannot complete a full 40-point test. Agreement with current standard tests is moderate to poor. Abnormal saccades cause an apparent non-specific visual field defect. In children with glaucoma or nystagmus SVOP calibration often fails.
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Affiliation(s)
- Vijay Tailor
- Department of Paediatric Ophthalmology and Strabismus, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Selina Glaze
- South Essex Partnership Foundation Trust, SEPT Community Health Services Bedfordshire, Enhanced Service Centre, Bedford, UK
| | - Hilary Unwin
- Sensory and Communication Support Team, Child Development Centre, Bedford, UK
| | - Richard Bowman
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Annegret Dahlmann-Noor
- Department of Paediatric Ophthalmology and Strabismus, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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