Case reportCognitive evolution of a girl submitted to right hemispherotomy when five years old
Introduction
The literature is rich in studies concerning neurocognitive evolution after neurosurgery in cases of drug-resistant partial epilepsy and hemiplegia associated with cortical malformations. Better results regarding epilepsy, adaptive functions and cognitive evolution are described after early surgery and reduction in or disappearance of seizures [1], [2], [3], [4].
Many papers are devoted to the development of linguistic abilities in left hemispherectomized patients [5], [6]; there are very few papers regarding cognitive development in patients who underwent right hemispherectomy [7], [8], [9].
Section snippets
Clinical evolution
Family and perinatal antecedents of this girl were silent. Psychomotor development was normal in spite of a mild left arm paresis.
B. had her first long-lasting non-motor seizure when 25 months old during a febrile illness. MRI evidenced a large micropolygyric malformation of the right fronto-temporo-parietal cortex (Fig. 1a–c).
Cognitive evaluation (Griffiths scales) showed a homogeneous mental age of 31.8 months.
When three years old she began having drug-resistant polymorphic seizures and the EEG
Discussion
When 25 months old, soon after the first seizure, our patient was submitted to a first cognitive evaluation, which showed a homogeneous developmental I.Q. superior to the normal level. The cognitive development became severely invalidated by the epileptic syndrome, which rapidly evolved into an epileptic encephalopathy, as signalled by Guerrini et al. [10].
Thanks to the early surgical intervention, which allowed a normal function of the left hemisphere, and the intensive cognitive rehabilitation
Acknowledgement
The authors would like to acknowledge a support from “Ricerca Sanitaria finalizzata 2006-08 - Regione Piemonte” to a locally organized research on “Prevention of cognitive and behavioral disorders in the severe epileptic pathology of children”.
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Cited by (6)
The hidden face of hemispherectomy: Visuo-spatial and visuo-perceptive processing after left or right functional hemispherectomy in 40 children
2022, Epilepsy and BehaviorCitation Excerpt :Considering the results reported in a more recent case study, it would seem as though the left hemisphere is not able to sustain nonverbal functions with the same efficiency as that with which the right hemisphere sustains the verbal functions after left hemispherectomy [18]. After a right hemispherectomy performed at age 5, the young girl described by Vigliano et al. showed normal cognitive level but mild deficits in the processing of complex visuo-spatial stimuli such as block designs and copy of the Rey complex figure [18]. Thus, the interest for visuo-spatial skills should not be limited to patients with right hemispherectomy.
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