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Journal Article
Systematic Review
Language after childhood hemispherectomy: A systematic review.
Neurology 2020 December 9
OBJECTIVE: To conduct a systematic review on language outcomes after left and right hemispherectomy in childhood, a surgical procedure that involves removing or disconnecting a cerebral hemisphere.
METHODS: We searched MEDLINE, Embase, and PsycInfo for articles published between January 1, 1988, and May 16, 2019. We included (1) all types of observational studies; (2) studies in which hemispherectomy was performed before age 18 years; and (3) studies with standardized scores measuring receptive vocabulary, expressive vocabulary, sentence comprehension, and/or sentence production. We calculated mean z scores after left and right hemispherectomy in the whole group and within etiology-specific subgroups.
RESULTS: Our search identified 1,096 studies, of which 17 were eligible. The cohort added up to 205 individuals (62% left hemispherectomy) assessed 1 to 15 years after surgery. In the left surgery group, all language skills were impaired ( z scores <-1.5) except sentence comprehension. In the right surgery group, language performance was in the borderline range ( z scores ∼ -1.5). Children with cortical dysplasia showed the worst outcomes irrespective of surgery side ( z scores <-2.5). Individuals with left vascular etiology and right-sided Rasmussen syndrome showed the best outcomes.
CONCLUSION: Evidence based on the largest patient cohort to date (205 participants) suggests that the risk of language impairment after hemispherectomy is high, with few exceptions. Etiology plays a major role in postsurgical plasticity. We recommend specialist evaluation of language skills soon after surgery to identify intervention targets. Large-scale studies examining outcomes in consecutive cases are still needed.
METHODS: We searched MEDLINE, Embase, and PsycInfo for articles published between January 1, 1988, and May 16, 2019. We included (1) all types of observational studies; (2) studies in which hemispherectomy was performed before age 18 years; and (3) studies with standardized scores measuring receptive vocabulary, expressive vocabulary, sentence comprehension, and/or sentence production. We calculated mean z scores after left and right hemispherectomy in the whole group and within etiology-specific subgroups.
RESULTS: Our search identified 1,096 studies, of which 17 were eligible. The cohort added up to 205 individuals (62% left hemispherectomy) assessed 1 to 15 years after surgery. In the left surgery group, all language skills were impaired ( z scores <-1.5) except sentence comprehension. In the right surgery group, language performance was in the borderline range ( z scores ∼ -1.5). Children with cortical dysplasia showed the worst outcomes irrespective of surgery side ( z scores <-2.5). Individuals with left vascular etiology and right-sided Rasmussen syndrome showed the best outcomes.
CONCLUSION: Evidence based on the largest patient cohort to date (205 participants) suggests that the risk of language impairment after hemispherectomy is high, with few exceptions. Etiology plays a major role in postsurgical plasticity. We recommend specialist evaluation of language skills soon after surgery to identify intervention targets. Large-scale studies examining outcomes in consecutive cases are still needed.
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