{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:31:12Z","timestamp":1790195472941,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T00:00:00Z","timestamp":1699660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Hemimegalencephaly (HME) is a rare congenital brain malformation presenting predominantly with drug\u2010resistant epilepsy. Hemispheric disconnective surgery is the mainstay of treatment; however, little is known about how postoperative outcomes compare across techniques. Thus we present the largest single\u2010center cohort of patients with HME who underwent epilepsy surgery and characterize outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational study included patients with HME at University of California Los Angeles (UCLA) from 1984 to 2021. Patients were stratified by surgical intervention: anatomic hemispherectomy (AH), functional hemispherectomy (FH), or less\u2010than\u2010hemispheric resection (LTH). Seizure freedom, functional outcomes, and operative complications were compared across surgical approaches. Regression analysis identified clinical and intraoperative variables that predict seizure outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 56 patients, 43 (77%) underwent FH, 8 (14%) underwent AH, 2 (4%) underwent LTH, 1 (2%) underwent unknown hemispherectomy type, and 2 (4%) were managed non\u2010operatively. At median last follow\u2010up of 55 months (interquartile range [IQR] 20\u201392 months), 24 patients (49%) were seizure\u2010free, 17 (30%) required cerebrospinal fluid (CSF) shunting for hydrocephalus, 9 of 43 (21%) had severe developmental delay, 8 of 38 (21%) were non\u2010verbal, and 15 of 38 (39%) were non\u2010ambulatory. There was one (2%) intraoperative mortality due to exsanguination earlier in this cohort. Of 12 patients (29%) requiring revision surgery, 6 (50%) were seizure\u2010free postoperatively. AH, compared to FH, was not associated with statistically significant improved seizure freedom (hazard ratio [HR]\u2009=\u2009.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.328), although initial AH trended toward greater odds of seizure freedom (75% vs 46%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.272). Younger age at seizure onset (HR\u2009=\u2009.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.029), lack of epilepsia partialis continua (EPC) (HR\u2009=\u2009.30,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.022), and no contralateral seizures on electroencephalography (EEG) (HR\u2009=\u2009.33,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.039) independently predicted longer duration of seizure freedom.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>This study helps inform physicians and parents of children who are undergoing surgery for HME by demonstrating that earlier age at seizure onset, absence of EPC, and no contralateral EEG seizures were associated with longer postoperative seizure freedom. At our center, initial AH for HME may provide greater odds of seizure freedom with complications and functional outcomes comparable to those of FH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.17807","type":"journal-article","created":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T04:23:15Z","timestamp":1698121395000},"page":"57-72","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Hemispheric epilepsy surgery for hemimegalencephaly: The UCLA experience"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8084-9298","authenticated-orcid":false,"given":"Keshav","family":"Goel","sequence":"first","affiliation":[{"name":"David Geffen School of Medicine at the University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0512-4590","authenticated-orcid":false,"given":"H. Westley","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4533-9476","authenticated-orcid":false,"given":"Jia\u2010Shu","family":"Chen","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Ngo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology David Geffen School of Medicine at the University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8872-6951","authenticated-orcid":false,"given":"Benjamin","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology David Geffen School of Medicine at the University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phong X.","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Radiology David Geffen School of Medicine at the University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Wang","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at the University of California  Los Angeles California USA"},{"name":"College of Medicine Charles R. Drew University of Medicine and Science  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4162-6096","authenticated-orcid":false,"given":"Alexander G.","family":"Weil","sequence":"additional","affiliation":[{"name":"Brain and Development Research Axis Sainte\u2010Justine Research Center  Montr\u00e9al, Qu\u00e9bec Canada"},{"name":"Department of Surgery, Division of Neurosurgery Sainte\u2010Justine University Hospital Centre  Montr\u00e9al, Qu\u00e9bec Canada"},{"name":"Department of Surgery, Division of Neurosurgery University of Montreal Hospital Centre (CHUM)  Montr\u00e9al, Qu\u00e9bec Canada"},{"name":"Department of Neuroscience University of Montreal  Montr\u00e9al, Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca E.","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Human Genetics, Division of Clinical Genetics David Geffen School of 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