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BACKGROUND
EFFECTIVE TREATMENT
REFRACTORY EPILEPSY
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FAMILY FACED WITH A CHILD
REQUIRING HEMISPHERECTOMY
OFTEN ASK
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MATERIAL AND METHODS
PREOPERATIVE DATA
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POSTOPERATIVE FUNCTIONAL OUTCOME
ASSESSED
Structured questionnaire
inquiring about functional
(ambulation, visual
symptomps, spoken language
and reading ability,
behavioural, and
academic/employment) and
seizure outcomes.
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OUTCOME DEFINITION
Poor outcome
Good outcome Unable to walk.
Independent walking Severe delay or 2-3
Age appropriate
word phrases only or
speaking or just below unclear words or
age level. nonverbal in speaking.
Age appropriate Able to read only
reading or few years familiar words or
below age. alphabets or unable to
No or minimal
read.
behavioural problems. Behavioural problems.
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Statistical Analysis
USING
TO COMPARE
PROVIDED DATA
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PREDICTORS OF POOR
FUNCTIONAL OUTCOME
Ambulatory Status
Structural abnormalities
in the nonoperated
hemisphere on MRI
Preexixting bilateral
Spoken Language Skills motor deficits
Preoperative language
delay or indeterminate
languange status (young
Reading Ability infants)
Postoperative seizure
recurrence
Behavioural Problem
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DISCUSSION
Plasticity proponents argue that
Boatman et brain in the growing phase is
al., 1999 & considered to be more plastic,
Ballantyne et and hence early injury may
al., 2007 be better compensated
especially if surgical treatment
is offered early
FOR EXAMPLE
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Proponents of the early
vulnerability model have reported
poorer
Anderson et cognitive and academic skills in
al., 2009, children with early brain
2010. injury compared to a similar
degree of brain injury in older
children
CONSEQUENTLY
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LIMITATION
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SUMMARY
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* Brain MRI abnormalities in the nonoperated
hemisphere predict poor motor and language
outcomes.
* Early interventions after hemispherectomy
to control seizure recurrence and provide
intensive language rehabilitation, when
appropriate, may seem prudent to improve
long-term functional outcome
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THANK YOU
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