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fMRI and DTI assessment of patients undergoing radical epilepsy surgery.

Abstract
Hemispherectomy is effective for young patients suffered from unilateral cortical disease and severe drug-resistant epilepsy, but a major concern for hemispherectomy is the remaining brain functions and function recovery in patients after such surgery. In this study, seven patients were evaluated with clinical and imaging assessment pre- and post-surgery. Among them, four underwent anatomic hemispherectomy (AH) and three underwent subtotal hemispherectomy (functional hemispherectomy, FH). After the surgery, 71.4% (5/7) patients [(4/4) with AH and (1/3) with FH] became seizure free (Engel class I). Motor function of the paretic upper extremity unchanged in 4 patients and deteriorated in 3. Functional imaging results indicated that relocation of hand motor function (to the ipsilateral hemisphere) could take place before or after the surgery, or did not occur. Similar observations were made in the motor cortex activation on the paretic foot movement. In addition, both the affected and unaffected hemispheres underwent post-surgical changes in the corticospinal tracks (CST) in various degrees, but significant reinforcement of the CST in the remaining unaffected hemisphere was not evident. Further research is needed to reveal the true functional and structural changes of the remaining brain after surgery and to explore the mechanisms of such functional relocation and reorganization in patients underwent hemispherectomy.
AuthorsJing Zhang, Shanshan Mei, Qingzhu Liu, Weifang Liu, Hui Chen, Hong Xia, Zhen Zhou, Lei Wang, Yunlin Li
JournalEpilepsy research (Epilepsy Res) Vol. 104 Issue 3 Pg. 253-63 (May 2013) ISSN: 1872-6844 [Electronic] Netherlands
PMID23340329 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2013 Elsevier B.V. All rights reserved.
Topics
  • Adolescent
  • Cerebral Cortex (physiopathology)
  • Child
  • Epilepsy (physiopathology, surgery)
  • Female
  • Hand (physiopathology)
  • Hemispherectomy (methods)
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging (methods)
  • Male
  • Recovery of Function
  • Young Adult

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