The Role of Inpatient Rehabilitation After Pediatric Epilepsy Surgery for Refractory Epilepsy
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SURGERY
The Role of Inpatient Rehabilitation After Pediatric Epilepsy Surgery for Refractory Epilepsy Eric A. Goethe 1 & Melissa A. LoPresti 1 & Christian Niedzwecki 2 & Sandi K. Lam 3,4 Accepted: 22 April 2020 # Springer Nature Switzerland AG 2020
Abstract Epilepsy surgery reduces seizure burden and antiepileptic use while improving quality of life. Neuroplasticity and rehabilitation aid in recovery after epilepsy surgery. We aimed to examine the impact and role of inpatient rehabilitation after epilepsy surgery in pediatric patients with refractory epilepsy. A retrospective chart review examined patients aged 0–18 years old undergoing epilepsy surgery for refractory epilepsy at our institution between 2012 and 2018, with subsequent admission to inpatient rehabilitation. Demographic, clinical, neurocognitive, and functional outcomes were measured. Thirty-six patients were included: 17 male (47.2%) and 19 female (52.8%). Mean age was 9.3 years (SD 5.2, range 1.1–18.9). The most common procedures were hemispherectomy (13, 36.1%) and lobectomy (12, 33.3%). The mean duration of rehabilitation was 16.2 days (SD 9.2, range 6–42). WeeFIMR scores improved after rehabilitation (65.6 vs. 49.3, p < 0.01). Improvement was seen in self-care (28.9 vs. 21.9, p < 0.01), mobility (19.6 vs. 13.7, p < 0.01), and cognition (17.2 vs. 13.7, p < 0.01) subscores. There was an association with sex and race/ethnicity with and change in WeeFIMR score after rehabilitation. Functional independence (mRS 0–2) at last follow-up was related to age (p < 0.04), preoperative mRS (p > 0.05), and procedure type (p < 0.02), with more independent patients undergoing lobectomy compared with hemispherectomy. Admission and discharge WeeFIMR scores were higher in those functionally independent compared with those functionally dependent at last follow-up (p < 0.01 for all subscores). No difference in change in WeeFIMR was seen between those functionally independent vs. dependent at last follow-up (p < 0.11). Postoperative inpatient rehabilitation after pediatric epilepsy surgery is associated with functional improvement in self-care, mobility, and cognition, but may be influenced by age or procedure type. Keywords Epilepsy surgery . Pediatric epilepsy . Refractory epilepsy . Rehabilitation . Neuroplasticity Abbreviations AEDs Antiepileptic drugs WeeFIM Functional Independence Measure for Children IRU Inpatient rehabilitation unit mRS Modified Rankin scale This article is part of the Topical Collection on Surgery No part of this work has been previously published. * Sandi K. Lam [email protected]; [email protected] 1
Department of Neurosurgery, Baylor College of Medicine, TX 77030 Houston, USA
2
Department of Physical Medicine and Rehabilitation, Texas Children’s Hospital, TX 77030 Houston, USA
3
Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children’s Hospital, IL 60611 Chicago, USA
4
Department of Neurosurgery, Northwestern University Feinberg School of Medicine, IL 60611 Chicago, USA
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