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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

Felippe Borlot 
1   Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Ivanna Yau 
1   Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Heather Olivieri 
1   Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
George M. Ibrahim 
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
,
O. Carter Snead III 
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
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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.

Keywords

Rasmussen's encephalitis - hemispherectomy - ethics - autonomy - shared decision-making


Publication History

Received: 21 March 2020

Accepted: 23 March 2020

Article published online:
08 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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