Improvement of language development after successful hemispherotomy

•Multilobar/hemispheric epilepsy is associated with severe encephalopathy.•Vertical hemispherotomy results in seizure-freedom and developmental progress.•The long post-operative follow-up revealed a slow developmental progress.•The study proves that severe handicapped children benefit from epilepsy surgery.

PurposeTo investigate language development after functional hemispherotomy and to evaluate prognostic factors for (un-)favourable outcomes.MethodsChildren and adolescents who had vertical perithalamic hemispherotomy at the Medical University Wien (MUW) paediatric epilepsy centre were identified from a prospectively maintained database. Inclusion criteria were: complete clinical, neurophysiological and neuropsychological data, seizure freedom and a minimum follow-up of 12 months after surgery. The language quotients (LQ) prior to surgery and at last follow-up were calculated for each child. In addition, associations between pre- to post-surgical changes in LQ and the following variables were examined: age at epilepsy-onset, age at surgery and duration of epilepsy prior to surgery, aetiology, side of surgery, interictal EEG including sleep organization before and 12 months after surgery and antiepileptic-drug (AED) withdrawal state at last follow-up. Analyses were carried out in SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Nonparametric Wilcoxon and chi-square tests were applied, as required.ResultsData from 28 children (14 female) were analyzed. The median age at epilepsy surgery was 64.5 months. The median follow-up after surgery was 3.0 years (±2.6 years, range 12 months to 12 years). Significant gains in LQs at last follow-up were found in 31% of the children (p = 0.008). Short disease duration prior to surgery, acquired pathology, lack of epileptiform EEG discharges in the contralateral hemisphere and/or normalization of EEG sleep patterns after surgery, and successful AED withdrawal were linked to favourable language outcomes.ConclusionSuccessful and early hemispherotomy results in improvement of language function in the intact hemisphere.