Abstracts

Extensive hemispheric injury can occur as the result of vascular disease from a variety of causes. Most patients are classified as infantile hemiplegia, usually the result of a prenatal, birth or neonatal injury. Epilepsy may considerably increase disability. In hospital-based series approximately 30% appear to have recurrent seizures. The response to anticonvulsant drugs is variable; approximately 20% will prove to be drug-resistant. We reviewed the data of 7 children with large cerebral vascular lesions, submitted to epilepsy surgery for intractable epilepsy related to a congenital vascular accident in 4; cardiac surgery in 2; viral myocarditis in one. All presented with mild to severe hemiparesis and intractable partial seizures, with secondary generalization in 2. Infantile spasms were the initial presentation in one. Epilepsy surgery consisted in simple evacuation of the porencephalic cyst or disconnection.
Three patients became seizure-free immediately after surgery and one after a second operation (left temporal lobectomy following a first operation for evacuation of the porencephalic cyst into the lateral ventricle). The sixth patient experienced 5 seizures within the year following surgery, to become seizure-free despite discontinuation of AEDs. The last patient showed considerable improvement but was not fully controlled and necessitated implantation of a VNS device. Follow-up varies from 12 months to 6 years.
Two children benefit from normal schooling, two are well integrated in professional education programs for adolescents with special needs and, one, with a previously catastrophic epilepsy shows considerable improvement n language acquisitions. Two previously retarded children showed no amelioration following surgery. In children with drug resistant epilepsy, related to the presence of extended vascular lesions, surgery must be discussed, as an alternative treatment, early in the course of the disorder.