PDF(Pubmed)
Abstract：
It is unclear whether a dominant hemispherectomy/hemispherotomy in someone with Rasmussen\'s Encephalitis (RE) may produce a satisfactory outcome when performed over the age of 40 years. Important questions include whether RE may continue to evolve three decades after onset, and whether a hemispherectomy may adequately shift language function when performed in older ages. Two cases illustrate seizure, language, motor and functional outcomes after dominant hemispherotomies. The cases were selected from an epilepsy surgery database of procedures performed at a private hospital in Cape Town, South Africa, spanning the period 1998-2023. A man in his 40s with epilepsy since childhood and dominant hemisphere RE partially regained impaired comprehension and ambulation, while expressive language function did not recover post-hemispherotomy. By contrast, a young teenage patient with dominant hemisphere RE demonstrated considerable recovery of expressive and receptive language and ambulation post-surgery. Both remain seizure-free. These two cases demonstrate that a dominant hemispherotomy, when performed on a quadragenarian, may produce a satisfactory, albeit inferior, functional outcome in comparison to when performed in childhood. RE may cause progressive neurological dysfunction in the late thirties and older and should be considered in patients presenting with functional decline decades after disease onset.
摘要：
尚不清楚Rasmussen脑炎（RE）患者的显性半球切除术/半球切开术在40岁以上进行时是否会产生令人满意的结果。重要的问题包括RE是否可能在发病后三十年继续发展，以及在老年人中进行大脑半球切除术是否可以充分改变语言功能。两个案例说明癫痫发作，语言,显性半信息切开术后的运动和功能结果。这些病例是从开普敦一家私立医院进行的癫痫手术数据库中选择的，南非,跨越1998-2023年。一名40多岁的男子自童年以来患有癫痫和优势半球RE，部分恢复了理解力和步行障碍，而表达性语言功能在大脑半球切开术后没有恢复。相比之下,一名患有优势半球RE的年轻青少年患者在手术后表现出表达性和接受性语言以及下床活动的显着恢复。两者都没有癫痫发作。这两个病例表明，显性半球切开术，当在四人组上表演时，可能会产生令人满意的，尽管劣等，与在儿童时期进行的功能结果相比。RE可能在30年代后期及以上引起进行性神经功能障碍，应在疾病发作后数十年出现功能下降的患者中考虑。
