PURPOSE For selected children with medically intractable epilepsy, hemispherectomy can be an excellent treatment option and its efficacy in achieving seizure freedom or reduction in seizure frequency has been shown in several studies, but patients' selection could not be straightforward and often it is taken on subjective basis. We described a multimodal approach to assess patient eligible for hemispherectomy and possibly predicting post-surgical outcomes. METHODS We describe pre- and post-surgical clinical features along with neuroradiological results by magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), MR-tractography (MRT), and neurophysiological study by single and paired pulses transcranial magnetic stimulation (TMS) in a child with cerebral palsy with epileptic encephalopathy, eligible for epilepsy surgery. RESULTS Presurgical TMS evaluation showed a lateralization of motor function on the left motor cortex for both arms, and results were confirmed by MRI studies. Interestingly, after surgery, both epilepsy and motor performances improved and TMS showed enhancement of intracortical inhibition and facilitation activity. CONCLUSION Functional hemispherectomy is an effective treatment for drug-resistant epilepsy, and multimodal presurgical assessment may be a useful approach to guide surgeons in selecting patients. Moreover, pre- and post-surgical evaluation of these patients may enhance our understanding of brain plasticity phenomena.

中文翻译：

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功能性半球切除术中运动通路和皮质内连接的多模式评估。

目的对于某些患有药物难治性癫痫病的儿童，半球切除术可能是一个很好的治疗选择，在几项研究中显示了其在实现癫痫发作自由或减少癫痫发作频率方面的功效，但患者的选择并不简单，通常是主观的基础。我们描述了一种多模式方法来评估有资格接受半球切除术并可能预测手术后结果的患者。方法我们通过磁共振成像（MRI），功能磁共振成像（fMRI），MR描记术（MRT）以及通过单脉冲和成对脉冲经颅磁刺激的神经生理学研究来描述手术前后的临床特征以及神经放射学结果（ （TMS）在患有癫痫性脑病的脑瘫患儿中，适合进行癫痫手术。结果术前TMS评估显示左臂两侧运动皮层的运动功能偏侧，MRI研究证实了这一结果。有趣的是，手术后，癫痫和运动表现均得到改善，TMS显示皮质内抑制和促进活性增强。结论功能性半球切除术是治疗耐药性癫痫的有效方法，多模式术前评估可能是指导外科医生选择患者的有用方法。此外，对这些患者进行手术前后的评估可能会增强我们对大脑可塑性现象的理解。癫痫和运动表现均得到改善，TMS显示皮层内抑制和促进活性增强。结论功能性半球切除术是治疗耐药性癫痫的有效方法，多模式术前评估可能是指导外科医生选择患者的有用方法。此外，对这些患者进行手术前后的评估可能会增强我们对大脑可塑性现象的理解。癫痫和运动表现均得到改善，TMS显示皮层内抑制和促进活性增强。结论功能性半球切除术是治疗耐药性癫痫的有效方法，多模式术前评估可能是指导外科医生选择患者的有用方法。此外，对这些患者进行手术前后的评估可能会增强我们对大脑可塑性现象的理解。