{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:06:18Z","timestamp":1789200378527,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n Rasmussen's encephalitis (RE) is a rare and progressive, immune\u2010mediated epileptic encephalopathy characterized by drug\u2010resistant seizures and neurological decline. While hemispheric disconnection (HD) is the gold standard treatment for effective seizure control, this procedure carries significant risk of permanent neurological sequelae. Systematic evaluation of both seizure and functional outcomes is essential to guide surgical decision\u2010making.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a retrospective cohort study using caregiver survey data from the Global Pediatric Epilepsy Surgery Registry. Children with RE who underwent HD and had complete postoperative data were included (\n n<\/jats:italic>\n \u2009=\u200937). The primary outcome was to examine pre and postoperative functional status, including seizure freedom, motor and mobility changes, visual impairments, language difficulties, operative complications, and caregiver\u2010reported quality of life (QoL) and regret. Multivariable analysis was run on candidate predictors (seizure onset, age at surgery, hemisphere of surgery, seizure frequency, number of surgeries, hydrocephalus).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Mean age at seizure onset was under 6\u2009years, with mean age at surgery 8.4\u2009years and mean time to surgery 3.6\u2009years. Postoperatively, 84.8% achieved seizure freedom, which correlated with QoL improvement (\n p<\/jats:italic>\n \u2009=\u2009.008). Hemiparesis increased from 22% to 97%; 35.8% lost the ability to run, 6.1% to walk, 6.4% to stand, and 31.2% to roll unassisted. Visual deficits rose from 16% to 84.4%. Left\u2010sided surgery predicted language deficits (\n p<\/jats:italic>\n \u2009=\u2009.019), while older age at surgery was associated with increased loss of motor milestones (\n p<\/jats:italic>\n \u2009=\u2009.016). Hydrocephalus occurred in 18.2%. Overall, 86% of caregivers reported QoL improvement; 54.8% wished surgery had been performed earlier, and 12.5% expressed regret.\n <\/jats:p>\n <\/jats:sec>\n \n Significance<\/jats:title>\n HD in pediatric RE yields high rates of seizure freedom and caregiver\u2010perceived QoL improvement but carries substantial risks of motor, language, and visual sequelae. These findings emphasize the importance of individualized, patient\u2010centered counseling and support the need for prospective studies to refine prognostic models and inform surgical decision\u2010making.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/epd2.70394","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:35:10Z","timestamp":1789198510000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative outcomes and predictors of functional sequelae following hemispheric surgery in Rasmussen's encephalitis: A retrospective cohort study from the global pediatric epilepsy surgery registry"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1993-3137","authenticated-orcid":false,"given":"Krish","family":"Nair","sequence":"first","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7800-7874","authenticated-orcid":false,"given":"Nicholas","family":"Benjamin","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8769-2238","authenticated-orcid":false,"given":"Emily","family":"Harford","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7425-3743","authenticated-orcid":false,"given":"Levi","family":"Shelton","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Heller","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2901-4903","authenticated-orcid":false,"given":"Katherine","family":"Cobb\u2010Pitstick","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Fernandez","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1193-6887","authenticated-orcid":false,"given":"Ross","family":"Carson","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6086-3236","authenticated-orcid":false,"given":"Monika","family":"Jones","sequence":"additional","affiliation":[{"name":"Pediatric Epilepsy Surgery Alliance Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Welch","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5089-460X","authenticated-orcid":false,"given":"Taylor J.","family":"Abel","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-9268","authenticated-orcid":false,"given":"Ruba","family":"Al\u2010Ramadhani","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S1474-4422(13)70260-6","article-title":"Rasmussen's encephalitis: clinical features, pathobiology, and treatment advances","volume":"13","author":"Varadkar S","year":"2014","journal-title":"Lancet Neurol"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1212\/WNL.8.6.435","article-title":"Focal seizures due to chronic localized encephalitis","volume":"8","author":"Rasmussen T","year":"1958","journal-title":"Neurology"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1093\/brain\/awh415","article-title":"Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement","volume":"128","author":"Bien CG","year":"2005","journal-title":"Brain"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1111\/epi.12334","article-title":"Clinical application and evaluation of the Bien diagnostic criteria for Rasmussen encephalitis","volume":"54","author":"Olson HE","year":"2013","journal-title":"Epilepsia"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/j.1468-1331.2007.01684.x","article-title":"Slowly progressive hemiparesis in childhood as a consequence of Rasmussen encephalitis without or with delayed\u2010onset seizures","volume":"14","author":"Bien CG","year":"2007","journal-title":"Eur J Neurol"},{"issue":"2","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.eplepsyres.2009.06.001","article-title":"Treatment of Rasmussen encephalitis half a century after its initial description: promising prospects and a dilemma","volume":"86","author":"Bien CG","year":"2009","journal-title":"Epilepsy Res"},{"issue":"10","key":"e_1_2_11_8_1","first-page":"1253","article-title":"The clinical MRI border zone in Rasmussen encephalitis","volume":"43","author":"Bien CG","year":"2002","journal-title":"Epilepsia"},{"key":"e_1_2_11_9_1","first-page":"395","article-title":"Recent advances in pathogenic concepts and therapeutic strategies in Rasmussen's encephalitis","volume":"161","author":"Bahi\u2010Buisson N","year":"2005","journal-title":"Rev Neurol (Paris)"},{"key":"e_1_2_11_10_1","first-page":"399","volume-title":"Epileptic seizures and syndromes","author":"Hart Y","year":"1994"},{"issue":"7","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.neurol.2022.01.007","article-title":"Medical treatment of Rasmussen's encephalitis: a systematic review","volume":"178","author":"Lagarde S","year":"2022","journal-title":"Rev Neurol (Paris)"},{"issue":"11","key":"e_1_2_11_12_1","first-page":"1428","article-title":"Hemispherectomy for intractable unihemispheric epilepsy: etiology, indications, surgical procedures, outcomes, and complications","volume":"44","author":"Kossoff EH","year":"2003","journal-title":"Epilepsia"},{"issue":"4","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3171\/2020.4.PEDS2098","article-title":"Epilepsy surgery for Rasmussen encephalitis: the UCLA experience","volume":"26","author":"Bellamkonda N","year":"2020","journal-title":"J Neurosurg Pediatr"},{"issue":"3","key":"e_1_2_11_14_1","first-page":"302","article-title":"Seizure outcomes in children with Rasmussen's encephalitis undergoing resective or hemispheric epilepsy surgery: an individual participant data meta\u2010analysis","volume":"25","author":"Harris WB","year":"2019","journal-title":"J Neurosurg Pediatr"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.yebeh.2023.109099","article-title":"Functional outcomes of pediatric hemispherotomy: impairment, activity, and medical service utilization","volume":"140","author":"Harford E","year":"2023","journal-title":"Epilepsy Behav"},{"issue":"2","key":"e_1_2_11_16_1","first-page":"169","article-title":"Complications of pediatric hemispherectomy: a systematic review and meta\u2010analysis","volume":"25","author":"Hemb M","year":"2019","journal-title":"J Neurosurg Pediatr"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","DOI":"10.1155\/2012\/527891","article-title":"Outcomes of disconnective surgery in intractable pediatric hemispheric and subhemispheric epilepsy","volume":"2012","author":"Thomas SG","year":"2012","journal-title":"Int J Pediatr"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1136\/jnnp-2012-303811","article-title":"Long\u2010term outcome of hemispheric surgery at different ages in 61 epilepsy patients","volume":"84","author":"Althausen A","year":"2013","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1542\/peds.100.2.163","article-title":"Why would you remove half a brain? The outcome of 58 children after hemispherectomy\u2014the Johns Hopkins experience: 1968 to 1996","volume":"100","author":"Vining E","year":"1997","journal-title":"Pediatrics"},{"key":"e_1_2_11_20_1","first-page":"609","volume-title":"Surgical treatment of the epilepsies","author":"Engel J","year":"1993"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.18338"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12342"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013\u20109580.2004.31803.x"},{"key":"e_1_2_11_24_1","first-page":"255","article-title":"The impact of hemispherectomy on cognitive and motor functions in children with Rasmussen encephalitis","volume":"51","author":"Jonas R","year":"2015","journal-title":"Epilepsy Behav"},{"issue":"3","key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/j.0013-9580.2004.15303.x","article-title":"The cognitive outcome of hemispherectomy in 71 children","volume":"45","author":"Pulsifer MB","year":"2004","journal-title":"Epilepsia"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.18391"}],"container-title":["Epileptic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epd2.70394","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epd2.70394","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epd2.70394","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:35:19Z","timestamp":1789198519000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epd2.70394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,12]]},"references-count":25,"alternative-id":["10.1002\/epd2.70394"],"URL":"https:\/\/doi.org\/10.1002\/epd2.70394","archive":["Portico"],"relation":{},"ISSN":["1294-9361","1950-6945"],"issn-type":[{"value":"1294-9361","type":"print"},{"value":"1950-6945","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,12]]},"assertion":[{"value":"2026-01-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"epd2.70394"}}