Journal of Pediatric Epilepsy 2020; 9(03): 059-066
DOI: 10.1055/s-0040-1710509
Review Article

The Dilemma of Hemispherectomy for Rasmussen's Encephalitis in a Neurologically Intact Child

1  Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
1  Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
1  Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
2  Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
3  Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
1  Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
4  Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations

Abstract

Rasmussen's encephalitis is a rare drug-resistant focal epilepsy characterized by progressive hemiparesis, hemianopia, and cognitive decline. Hemispherectomy is currently the only known treatment that can be curative, though expected to cause postoperative motor and visual deficits in children and adolescents. To date, medical treatment with antiseizure medications and immunosuppressive agents can only offer partial, delayed, or temporary alleviation of symptoms. Hence, patients and families are often faced with the difficult decision to consider the possibility of seizure freedom at the cost of incurring permanent deficits. Here, we discussed the unique ethical issues when faced with a cure that can cause harm, and also discussed a shared decision-making approach guided by informed consent, principles of autonomy, and patient-centered values.



Publication History

Received: 21 March 2020

Accepted: 23 March 2020

Publication Date:
08 May 2020 (online)

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