Introduction:

Hemispherotomy is an effective treatment option for medically refractory epilepsy caused by extensive congenital or acquired hemispheric lesions. Very few studies about hemispherotomies are available in literature.

Materials and methods

We Prospectively studied patients with catastrophic epilepsy, who underwent  hemispherotomies from June 2015 to June 2017. These patients were evaluated for clinical characteristics, etiology,  imaging features, video EEG characteristics and functional outcome.

Results

A total of 120 patients, who underwent epilepsy surgery at our centre, 19 (15.8%) underwent hemispherotomy. Pathological spectrum included hemimegelenchephay (7), HHE (4), perinatal insults (4) and rasmussen’s encephalitis (4). Twelve patients had developmental delay. Seven patient had one or more episodes of status epilepticus.Average number of seizures recorded were10 & duration of video EEG was 12 hours. Pseudo lateralisation in ictal onset was seen in 4 patients and semiology was the key to lateralization. Hemiparesis with dysfunctional hand was present in all except one preoperatively. Six patient underwent hemispherotomy as emergency surgery. Ten patients had worsening of motor weakness, which improved to preoperative levels in 3 weeks. Three patients required redo procedures for incomplete procedures at first time. Engel class 1a outcome was seen in 14 patients, 2a in 4 patients and class 4 in one patient. Average duration of follow up is12 months  ( 4-24month). Average antiepileptic drugs were reduced to 2 from preoperative average of 4.

Conclusion:

Hemispherotomy offers good seizure control and significantly improves cognition, quality of life in catastrophic drug resistant hemispheric epilepsies.