J.Jpn. Surg. Soc.. 61(9): 1200-1218, 1960

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Original article

CLINICAL ELECTROENCEPHALOGRAPHIC STUDIES OF INFANTILE HEMIPLEGIA TREATED BY CEREBRAL HEMISPHERECTOMY

Nine patients with severe epileptic attack, mental deterioration and clinical picture of infantile hemiplegia have been followed-up for adout 5 to 43 months after hemispherectomy including the caudate and lentiform nuclei sparing the thalamus. Left hemispheres were removed in 7 cases and the others were right. The residual neurological picture has not much changed the preoperative conditions except for a homonymous hemianopia sparing macular vision.
1) The preoperative EEG ranged from slightly abnormal to very abnormal on both sides but asymmetrical pattern was observed in all cases. These EEG abnormalities were rhythmical high voltage slow waves, spikes, non-specific dysrhythmia and electrical silence. Generally a high degree of concord exsists among the laterality of clinical involvements, pneumoencephalographic abnormalities and laterality of the EEG abnormalities.
2) The EEG on remaining hemisphere where we saw abnormality preoperatively showed a continuing tendency to normalization postoperatively. In quiet state postoperative EEG of 4 patients have shown normal pattern and in others slight abnormalities have persisted but these abnormalities were improved. In general the sleep pattern was seen unchanged after hemispherectomy.
3) The hemispherectomized side showed the electrical activity even if the lower one and α rhythm has been recorded in occipital regions in 5 cases at that sides (10-30μV). These activities fluctuate with the activity of the remained side in amplitude and frequency, as if they were smaller version.
Even after the replacement of C.S.F. in the absent cavity with air these activies were almost unchanged and in some cases would be rather higher, while these were reduced in amplitude at the further lateral portion. Probably, therefore, volume conduction may spread from the intact side through the mass resistance of C.S.F., skull and scalp, especially the latters.
4) The best therapeutic results were seen in epileptic phenomena and emotional instability. A complete abolition of the epileptic seizures occurred in 5 cases without any medication and others have greatly improved. In 6 cases behavioral and emotional disturbances were dramatically improved and became sociable. The potoperative EEG in these patients were also greatly improved.
(Author's abstract)

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