Epilepsy associated with infantile hemiplegia in adult: Clinical characteristics and results of surgery

Kim, Joo Yong; Lee, Sang Kun

Abstract

BACKGROUND: Many children with acute infanti]e hemiplegia (AIH) develop epilepsy later. Epilepsy associated with AIH has been generally thought to be medical]y intractable and difficult to be treated surgically. We report 15 patients with intractable epilepsy associated with AIH, 10 of whom received surgery.
METHODS
All patients underwent comprehensive presurgical evaluation, including video-EEG monitoring, MRI, PET, interictal and ictal SPECT.
RESULTS
The onset of AIH was at mean age of 19 months, accompanied by hyperpyrexia and repeated convulsion. Subsequent epilepsy started at mean age of 11 years, which could be subdivided by mesial temporal lobe epilepsy (MTLE) in 8 patients (53%) and neocortical or multifocal epilepsy in 7 patients (47%). The mean age of onset of AIH was earlier in MTLE group and the mean age of onset of subsequent epilepsy was earlier in neocortlcal group, although not significant statistically. The patients demonstrated variable spectrums of abnormalities on EEG, MRI, PET, and SPECT, but neocortica] group tended to show more widespread abnormalities than MTLE group. Surgery was performed in 7 of 8 in MTLE group and 3 of 7 in neocortica] group, and the outcome was excellent in MTLE group.
CONCLUSION
Epilepsy associated with AIH showed two distinct subtypes; MTLE and neocortical/multifoca] epilepsy. Because the surgical outcome in selected cases with well-localized epileptogenic zone was excellent, careful clinical consideration and presurgical evaluation will be needed for management planning and to avoid unnecessary hemispherectomy.