Infant Hemispherectomy for Hemimegalencephaly: Why Early Referral Matters

Hemimegalencephaly can cause drug-resistant epilepsy in infants. Learn when to refer for hemispherectomy and what the evidence shows.

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Hemimegalencephaly is rare and often causes catastrophic, drug-resistant epilepsy involving most of the affected hemisphere.
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Persistent seizures despite two appropriately dosed and tolerated medications, or seizures with an abnormal MRI finding, warrant prompt evaluation at a specialized pediatric epilepsy center.
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Intractable epilepsy is an independent risk factor for developmental delay and sudden unexpected death in epilepsy, supporting early imaging and referral.
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Hemispherectomy remains the gold standard treatment for HME-associated epilepsy, and surgery may be considered in infancy at experienced centers.
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At Phoenix Children’s, fewer than 15% of hemispherectomy patients require a shunt for postoperative hydrocephalus.

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