2022 Volume 54 Issue 4 Pages 247-251
Objective: To investigate long-term functional outcomes of children with hemimegalencephaly after hemispherotomy to develop appropriate interventions based on adequate goals. Methods: We retrospectively evaluated nine children (2 males and 7 females; age at evaluation 6-18 years) with hemimegalencephaly who had visited Bobath Memorial Hospital from January 2001 to July 2020. Outcomes of epileptic seizures, gross motor function, upper limb function of the affected side, and intellectual development were investigated. Results: All nine children had undergone hemispherotomy. The age at the surgery was between 2 and 42 months (median 6 months), and more than 5 years had passed until the time of investigation. Epileptic seizures had disappeared in seven children and remained in two. Seven of the nine children could walk independently and the age at initial walk was between 3 and 7 years (median age, 4 years). All the children needed orthosis for the affected lower limb, and two had undergone orthopedic surgery for clubfoot. Regarding the function of the affected upper limb, five could grasp and release objects, and four could move the shoulder or elbow with some limitations. Among the eight children consecutively evaluated using the Kyoto Scale of Psychological Development 2001, seven showed moderate or severe intellectual disability (developmental quotient<50) after infancy, but four out of all had gradually developed and attained intellectual ability better than that at late infancy. Conclusions: Children with hemimegalencephaly, in addition to early epilepsy surgery and medication, require physical therapy, orthosis, and orthopedic treatment for achieving independent walking, occupational therapy for better utilization of the affected upper limb, and special educational support for facilitating intellectual development through collaborated multidisciplinary interventions.
