The purpose of this study is three-fold: First, to determine the levels of gross and fine motor functions in children before and after hemidecortication, using standardized measurement tools; second, to investigate if predictors of these outcomes can be characterized; and third, to explore if both clinical measures and functional magnetic resonance imaging (MRI) potentially can identify optimal timing of surgery. The Gross Motor Function Measure and the Quality of Upper Extremity Skills Test are shown to be comprehensive, standardized outcome measures of movement performance in affected children. Age at surgery and interval between age at seizure onset and age at surgery could be the most reliable predictors of clinical outcomes. Functional MRI studies are valuable in exploring the potential of the cortical reorganization that sustains residual sensorimotor function. The combination of clinical measures with functional MRI is a promising method of inquiry into developmental and plasticity processes. (J Child Neurol 1999;14:304-315).
Get full access to this article
View all access options for this article.
References
1.
Hoffman HJ, Hendrick EB, Dennis M., et al: Hemispherectomy for Sturge-Weber syndrome. Childs Brain1979;5:233-248.
2.
Peacock WJ, Wehby-Grant M., Shields WD, et al: Hemispherectomy for intractable seizures in children: A report of 58 cases. Childs Nerv Syst1996; 12:376-384.
3.
Hwang PA, Engel J. Jr: Surgical Treatment of the Epilepsies. New York , Raven Press, 1993, pp 714-716.
4.
Carmant L., O'Tuama LA, Roach PJ, et al: Technetium-99m HmPAO brain SPECT and outcome of hemispherectomy for intractable seizures. PediatrNeurol1994 ;11:203-207.
5.
Lindsay J., Ounsted C., Richards P.: Hemispherectomy for childhood epilepsy: A 36-year study. Dev Med Child Neurol1987;29:592-600.
6.
Crandall PH: Clinical phenomenology following hemispherectomy and the syndromes of hemispheric disconnection, in Ben-son DF , Zaidel E (eds): The Dual Brain. New York, Guilford Press, 1995, pp 277-287.
7.
Chugani HT, Jacobs B.: Metabolic recovery in caudate nucleus of children following cerebral hemispherectomy . Ann Neurol1994; 36:794-797.
8.
Villemure JG , Rasmussen T.: Functional hemispherectomy in children. Neuropediatrics1993;24:53-55.
9.
Smith Sjm, Andermann F., Villemure JG, et al: Functional hemispherectomy: EEG findings, spiking from isolated brain postoperatively, and prediction of outcome. Neurology1991;41:1790-1794.
10.
Vigevano F. , Bertini E., Boldrini R., et al: Hemimegalencephaly and intractable epilepsy: Benefits of hemispherectomy. Epilepsia1989;30:833-843.
11.
Verity CM, Strauss EH, Moyes PD, et al: Long-term follow-up after cerebral hemispherectomy: Neurophysiologic, radiologic, and psychological fmdings. Neurology1982;32:629-639.
12.
Beckung E., Uvebrant P.: Motor and sensory impairments in children with intractable epilepsy . Epilepsia1993;34:924-929.
13.
Beckung E., Uvebrant P., Hedstrom A., et al: The effects of epilepsy surgery on the sensorimotor function of children. Dev Med Child Neurol1994;36:893-901.
14.
Pawlik G., Holthoff VA, Kessler J., et al: Positron emission tomography findings relevant to neurosurgery for epilepsy. Acta Neurochir (Wien)1990 ;50:84-87.
15.
Muller R-A. , Rothermel RD, Behen ME, et al: Plasticity of motor organization in children and adults. Neuroreport1997;8:3103-3108.
16.
Graveline C. , Mikulis D., Crawley A., et al: Evidence of regionalized sensorimotor plasticity after hemispherectomy for epilepsy: Evaluation by functional magnetic resonance imaging. Pediatr Neurol1998;19:337-342.
17.
Hammeke TA, Yetkin FZ, Mueller WM, et al: Functional magnetic resonance imaging of somatosensory stimulation . Neurosurgery1994;35:677-681.
18.
Rao SM, Binder JR, Hammeke TA, et al: Somatotopic mapping of the human primary motor cortex with functional magnetic resonance imaging. Neurology1995 ;45:919-924.
19.
Pujol J., Conesa G., Deus J., et al: Presurgical identification of the primary sensorimotor cortex by functional magnetic resonance imaging. J Neurosurg1996;84:7-13.
20.
Russell D., Rosenbaum P., Gowland C., et al: Gross Motor Function Measure Manual. Hamilton, ON, McMaster University, 1990, pp 1-88.
21.
DeMatteo M., Law M., Russell D., et al: QUEST, Quality of Upper Extremity Skills Test, Manual. Hamilton, ON, McMaster University, 1996.
22.
Resnick TJ, Duchowny M., Jayakar P:Early surgery for epilepsy: Redefining candidacy. J Child NeuroL1994;9:36-41.
23.
Chugani HT, Phelps ME, Mazziotta JC: Positron emission tomography study of human brain functional development . Ann Neurol1987;22:487-497.
24.
Boyce WF, Gowland C., Rosenbaum PL, et al: Measuring quality of movement in cerebral palsy: A review of instruments. Phys Ther1991;71:813-819.
25.
Cole B., Finch E., Gowland C., et al: Physical Rehabilitation Outcome Measures. Toronto, Canadian Physiotherapy Association, 1994, pp 1-222.
26.
Rosenbaum PL , Cadman D., Russell D., et al: Issues in measuring change in motor function in children with cerebral palsy. Phys Ther1990;70:125-131.
27.
Russell D., Rosenbaum P., Gowland C., et al: Validation of a gross motor measure for children with cerebral palsy. Physioth Can1990; 42:3.
28.
Russell D., Rosenbaum P., Cadman D., et al: Gross Motor Function Measure (GMFM): A Measure of Gross Motor Function in Cerebral Palsy. Hamilton, ON, McMaster University , 1990.
29.
Russell D., Rosenbaum P., Cadman D., et al: The gross motor function measure: A means to evaluate the effects of physical therapy. Dev Med Child Neurol1989;31:341-352.
30.
Law M., DeMatteo M., Russell D., et al: Validation of the Quality of Upper Extremity Skills Test for Children With Cerebral Palsy. Hamilton, ON, McMaster University , 1990.
31.
Strupp JP: Stimulate: A GUI base fMRI analysis software package. Neuroimage1996;3:S607.
32.
Duchowny MS : Surgery for intractable epilepsy: Issues and outcome. Pediatrics1989;84:886-894.
33.
Maria BL, Ringdahl DM, Mickle JP, et al: Intraventricular alpha interferon therapy for Rasmussen's syndrome. CanJ NeuroL Sci1993;20:333-336.
34.
Rintahaka PJ , Chugani HT, Messa C., et al: Hemimegalencephaly: Evaluation with positron emission tomography. Pediatr NeuroL1993;9:21-28.
35.
Kennard MA: Age and other factors in motor recovery from pre-central lesions in monkeys . Am J PhysioL1936;115:138-14G.
36.
Kennard MA, Fulton MF: Age and reorganization of central nervous system. J Mt Sinai Hosp1942;9:594-606.
37.
Kolb B.: Brain Plasticity and Behaviour. Mahwah, NJ, Lawrence Erlbaum Assoc, 1995.
38.
Huttenlocher PR: Synapse elimination and plasticity in developing human cerebral cortex. Am J Ment Defic1984 ;88:488-496.
39.
Huttenlocher PR: Morphometric study of human cerebral cortex . Dev Neuropsychologia1990;28:517-527.
40.
Foerster O.: The motor cortex in man in the light of Hughlings Jackson's doctrines . Brain1936;59:135-159.
41.
Penfield W., Boldrey E.: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain1937 ;60:389-443.
42.
Kalaska J., Pomeranz B.: Chronic paw denervation causes age-dependent appearance of novel responses from forearm in 'paw cortex' in kittens and adult cats. J Neurophysiol (Lond)1979;42: 618-633.
43.
Franck JI: Functional reorganization of cat somatic sensory-motor cortex after selective dorsal root rhizotomy. Brain Res1980; 186:458-462.
44.
Boecker H., Kleinschmidt M., Requardt M., et al: Functional cooperativity of human cortical motor areas during self-paced simple finger movements—A high resolution MRI study. Brain1994;117: 1231-1239.
45.
Connelly A. , Jackson GD, Frackowiak RS, et al: Functional mapping of activated human primary cortex with a clinical MR imaging system. Radiology1993;188:125-130.
46.
Sanes JN, Donoghue JP, Thangaraj V., et al: Shared neural substrates controlling hand movements in human motor cortex. Science1995;268:1775-1777.
47.
Ramsey NF, Kirkby BS, Van Gelderen P., et al: Functional mapping of human sensorimotor cortex with 3D BOLD fMRI correlates highly with H215O PET rCBFJ Cereb Blood Flow Metab1996;16: 755-764.
48.
Puce A., Constable T., Luby ML, et al: Functional magnetic resonance imaging of sensory and motor cortex: Comparison with electrophysiological localization. JNeurosurg1995;83:262-270.
49.
Colebatch JG , Deiber M-P., Passingham RE, et al: Regional cerebral blood flow during voluntary arm and hand movements in human subjects. J Neurophysiol199 1; 65:1392-1400.
50.
Kawashima R. , Itoh H., Ono S., et al: Changes in regional cerebral blood flow during self-paced arm and finger movements. Brain Res1996;716:141-148.
