PART 2: LITERATURE REVIEW TABLE

Running head: BRAIN HEMISPHERECTOMY: A LITERATURE REVIEW 1

BRAIN HEMISPHEROCTOMY: A LITERATURE REVIEW 2

Brain Hemispherectomy: A Literature Review

Gloria Okoye

Walden University

Course Instructor

Date

Introduction

Conventional medicines have proved inefficient in treating the occurrence of seizures in epileptic patients. The occurrence of drop attacks and massive jerking movements have proven persistent in these patients. This then has necessitated the shift to find other forms of mitigating these attacks and improving the overall quality of lives of these patients. Hemispherectomy and Corpus callostomy have been employed to aid these patients in their recovery from such attacks.

Hemispherectomy generally entails the removal of one side of the affected brain in order to reduce epileptic attacks. Corpus Callostomy on the other hand, entails the splitting of the brain that is; disconnecting the corpus callosum, which is a nerve rich fiber that interconnects the two brain hemispheres. However, adult patients who have undergone the hemispherectomy procedure have been found to have acquired Aphasia later on in their lives. Children who had undergone the same procedure showed remarkable recovery within a period of 6 months and had regained their cognitive abilities by then.

Corpus callostomy procedure had shown a positive result in adults as they retained most of their cognitive abilities than when they underwent the hemispherectomy procedure. This result has raised questions among the research as to whether corpus colostomy should be performed on adults more than in children in order to maintain their cognitive abilities even after surgery. The paper seeks to state the findings on investigations that clearly point to the best surgical procedure that is feasible and will have fewer detrimental effects on adults who undergo them.

Findings

A research carried out on 33 children who had undergone hemispherectomy in London, showed that most of them made a full recovery after their surgical procedure (Devlin et al., 2003). According to the result statistics after the surgical procedure, 52% of them were completely free from seizures; 9% of them experienced rare seizures; 30% showed a 75% reduction on seizure occurrence while the rest showed seizure reduction or no improvement. While this is the case, the same procedure performed on adults proved to bear different results. According to studies carried out by Schneider (1974), there were findings of adults who lost their cognitive abilities after undergoing hemispherectomy procedures. Schneider owed it to the children’s brain plasticity as most of their cognitive abilities which are handled by the left hemisphere of the brain were transferred to the right hemisphere of their brains. These findings were further supported after the successful recovery of a 9 year old boy who had undergone hemispherectomy (Isaacs et al., 1997)

According to Springer and Deutsch (1993), all or most of the brains cognitive abilities are localized in the left side of the brain. According to their research on the correlation between being either left or right-handed and brain localization, they found out that: 95% of the right-handed individuals had most of their speech cognitive abilities centered in the left side of the brain; while 70% of all left-handed individuals had their speech centers in the left-side of the brain. The rest had their speech functions evenly distributed between both hemispheres. The results explain why cognitive abilities got impaired after hemispherectomy.

According to studies by the Epilepsy foundation (2008), they found out that corpus callostomy patients who had undergone the procedure had retained their cognitive abilities. The patients also experienced reduced epileptic attacks. The procedure is seen as the best alternative to brain hemispherectomy, as adults were more likely to lose their cognitive abilities than children who underwent the same procedure.

Assessing Quality of Study

The studies clearly show that the brain’s left hemisphere handles most of the cognitive functions of the human brain. Epilepsy, which affects the cognitive functions is a big impediment to the full enjoyment of life. Surgical procedures have been devised to mitigate the degenerative effects of it. Clearly, one procedure does not offer the same end results to patients. It is because most adults acquired degenerative conditions that is, Aphasia. Children on the other hand, had a remarkable recovery after undergoing the same hemispherectomy procedure that was conducted in adults. However, Corpus callostomy has indeed been found to have a positive impact on children and more so adults as they retained most of their cognitive abilities and reduced their occurrence of seizures. Therefore, Corpus callostomy should be performed as an alternative to hemispherectomy as it promises better results in adults with seizures.

Summary of Evidence

According to the study undertaken, corpus callostomy poses greater advantages than hemispherectomy in adults. It is because their brains are not placid, hence they would lose most of their cognitive abilities after surgery as compared to children.

Literature Review Matrix Template

Author/ Date	Research Question(s)/ Hypotheses	Methodology	Analysis & Results	Conclusions	Implications for Future research	Implications For practice
Springer & Deutsche (1993)	Whether there is a correlation between the brain localization and being either left-handed or right handed.	Observing the language localization hemisphere in both left and right handed individuals.	90% of right handed and 70% of left handed people had their language cognitive abilities in the left hemisphere. The rest had their abilities evenly distributed between both hemispheres.	Brain cognitive abilities are mostly located in the left hemisphere.	Most individuals have their cognitive abilities in the left hemisphere	This will form basis especially when considering surgery on either sides of the brain.
Schneider, G.E., & Jhaveri, S.R (1974)	To ascertain whether adults can recover fully from surgical procedures of hemispherectomy	Observing results after surgery on both adults and children	Adults lost most of their cognitive abilities after surgery	Adults have less placid brains than children	This will form basis when studying on the plasticity of the brain	It will guide professionals on decisions prior to surgery on either adults or children
Isaacs et al. (1997)	Whether a 9 year old made full recovery after hemispherectomy procedure	Monitoring recovery process of the boy	The boy made impressive recovery after the procedure was performed	Children have more placid brains	Further research on how to treat brain conditions through hemispherectomy.	It will aid professionals when making decisions on the right procedure for children to achieve best results
Devlin et al. (2003)	To ascertain whether hemispherectomy had positive outcomes in children	To study recovery results for 33 children	Most children had a full recovery after surgery.	The procedure had a positive outcome in children	This will guide on researching more on clinical based surgeries on treatment of epilepsy.	It will form a basis when deciding on the best procedure to perform on epileptic children
Epilepsy foundation (2008)	To ascertain whether corpus callostomy can be used as an alternative in adults.	To study results of adults after undergoing the procedure	Adults retained their cognitive abilities and reduced seizure attacks	Corpus callostomy is more advantageous than hemispherectomy	This will aid researchers in finding and detailing the best seizure treatment approach for adults	Hemispherectomy will be abandoned for corpus callostomy in treating adult epilepsy.

References.

Devlin, A.M., Cross, J.H., Harkness W., Chong, W.K., Harding B., Vargha-Khadem, F., &

Neville, B.G. (2003). “Clinical outcomes of hemispherectomy for epilepsy in childhood

And adolescence.” Brain; 126,556±566

Epilepsy Foundation. (2008). “Not another Moment Lost to Seizures.” 176SRG. Retrieved from

http://www.epilepsyfoundation.org

Isaacs, E., Faraneh, V.K., Lucinda, J.C., Edward, B., Christopher A., & Mortimer M. (1997).

“Onset of speech after left hemispherectomy in a nine-year-old boy.” Brain; 120,159–182

Schneider, G.E., & Jhaveri, S.R. (1974). Plasticity and Recovery Function in the Central

Nervous System. Academic Press; New York: pp 65-109

Springer, S & Deutsch, G. (1993). Left brain, Right brain . Freeman: New York.