Running head: BRAIN HEMISPHERECTOMY: A LITERATURE REVIEW 1 BRAIN HEMISPHEROCTOMY: A LITERATURE REVIEW 2 Brain Hemispherectomy: A Literature Review Gloria Okoye Walden University NURS-6052N/NURS-5052-1:Essential of Evidence –Based Practice. 04/05/15 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 ...

1. Running head: BRAIN HEMISPHERECTOMY: A
LITERATURE REVIEW 1
BRAIN HEMISPHEROCTOMY: A LITERATURE REVIEW
2
Brain Hemispherectomy: A Literature Review
Gloria Okoye
Walden University
NURS-6052N/NURS-5052-1:Essential of Evidence –Based
Practice.
04/05/15
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

2. 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

3. 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

4. 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.

5. 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)

6. 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.

7. 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.

8. Running head: IDENTIFYING RESEARCHABLE PROBLEM
1
PICOT AND EVIDENCE BASED PRACTICE QUESTION
2
PICOT and Evidence Based Practice Question
Gloria Okoye
Walden University
NURS-6052N-1/NURS-5052-1, Essential Evidence Based
Practice
2/14/15
Introduction
The purpose of this paper is to identify the area of my PICOT
question of interest which is “What is practice issue”?, discuss
some of the practice issues related to brain Hemipherectomy
effect on adults cognitive abilities vs. children, identify some
risk factors related to hemipherectomy, and be able to analysis
my PICOT variables that will help me determine my question

9. and then develop keyword that would during literature research.
PICOT and Evidence Based Practice
Question
PICOT and Evidence Based Practice Question
What is the Practice Issue?
The following is the Practice Issue For The Study. “Does brain
hemispherectomy have more detrimental effects on an adult’s
cognitive abilities than in children due to their brain’s plasticity
over a period of six months?”
The chances of one developing postoperative Aphasia are higher
in adults than in children. Researchers define Aphasia as a
condition that develops due to a person’s anatomical cognitive
abilities getting impaired. This can be through the lesions. The
condition can be classified as either: Broca’s or Wernicke’s
Aphasia. Aphasics have been shown to be poor in their
communication skills, but have fairly commendable intellectual
abilities. Brain hemispherectomy has in the past been performed
on epileptic patients that failed to show positive improvement
while under medication. This then necessitates the removal of
one of the brain’s hemispheres to help reduce the occurrence of
seizures and improvement of the patient’s overall quality of
life.
Whilst, most patients actually recorded a positive reduction or
complete elimination of their seizures, some lost most of their
language cognitive abilities. Most of them also had a much
harder time identifying and naming objects/tools that were
placed in their right hands than when the same objects were
placed in their left hands, a few months after the surgery. This
has raised questions among health professionals as to what
approach should be considered when dealing with an adult
epileptic patient. There has been consideration of the
suggestions on the abandonment of hemispherectomy and
embracing of the alternative Corpus Callostomy to regulate
electrical activity in the brain. It is because studies have shown
that children had a quicker recovery time from seizures and did
not have to grapple with the detrimental effects after removal of

10. one their brain hemisphere. It has been accredited to their
brain’s plasticity; where, their language and cognitive abilities
are allocated to the brain’s right hemisphere.
What is the practice area?
Clinical
I work as a nurse at the Angels Health Centre in California. It is
a 500 licensed bed capacity hospital with 450 physicians. It is a
revered medical Centre having pioneered numerous researches
on global medicine. It acts as a research hub for practicing
physicians and medical students. The institution has various
departments, namely: Nutrition and dietetics, oncology,
gynecology, ophthalmology, dermatology, pediatrics and
dentistry departments. The institution has, to date, been able to
carry out 500 children hemispherectomy surgeries and about
300 adults on the same. It has also performed 259 corpus
callostomy surgeries with an 87% success rate on all the
performed surgeries.
How was the practice issue identified?
Contrasting end results between young and mature adult patients
before and after surgery;
· Most of the adult and children patients had gotten relief from
their seizures after surgery.
· Most of the adult cognitive abilities deteriorated most of
which include: their linguistic abilities and their quick
identification of things.
· There had been coverage of successful treatment of epilepsy in
children than in their adult counterparts.
Wide Variation in Practice.
There had been evidence of successful hemispherectomy in
children and adults leading to the complete elimination of
seizures. However, there had been challenges of adults
acquiring Aphasia after the surgery. The research was
conducted using the following healthcare sites;

11. http://ncbi.nlm.govhttp://jnnp.bmj.com,
http://surgeryencyclopedia.com , http://researchgate,
http://clevelandclinic.org. There had been close selection of
articles that contained scientific detail backing, documented
cases of real life patients who underwent the procedure and
their outcomes thereafter.
What is the scope of the problem?
The scope of the problem had been adults and children patients
who had undergone hemispherectomy surgery within the health
facility. The patients were between 3 and 55 years of age. The
study only pondered on the effects that hemispherectomy had on
both the young and the older patients within a six month period.
What is the PICOT question?
“Does brain hemispherectomy have more detrimental effects on
an adult’s cognitive abilities than in children due to their
brain’s plasticity over a period of six months?”
P-Population-Epileptic patients between the ages of 3-55 years.
I-Intervention-Hemispherectomy surgery.
C-Comparison-Children’s quick recovery from surgery with no
complications thereafter.
O-Outcome-Aphasia manifesting itself in adults
T-Time-A period of six months
What evidence must be gathered?
a) Literature search
http://ncbi.nlm.gov –National Center for Biotechnology
Information
b) Surgical procedure
http://surgeryencyclopedia.com -
c) Aphasia after surgery
http://ncbi.nlm.gov - National Center for Biotechnology
Information
http://connects.caralyst.harvard.edu –Harvard university
http://clevelandclinic.org. -Cleveland clinical complex
d) Real life cases of epileptic patients after surgery

12. http://ncbi.nlm.gov- National Center for Biotechnology
Information
http://surgeryencyclopedia.com - Encyclopedia of surgery: A
guide for caregivers and patients
http://jnnp.bmj.com
e) Children after surgery
https://ncbi.nlm.nih.gov - National Center for Biotechnology
Information
f) Brain Localization
www.ncbi.nlm.gov- National Center for Biotechnology
Information
g) Brain cognitive abilities
www.web.stanford.education -Stanford education center
h) Language and the brain
www.linguisticsociety.org –Linguistic society
i) Recovery time after surgery
www.ncbi.nlm.gov - National Center for Biotechnology
Information
j) Other forms of surgical procedures on Epileptics
www.surgeryencyclopedia.org –Encyclopedia of surgery: A
guide for caregivers and patients
State the search question in narrow, manageable terms:
What are the effects of the hemispherectomy procedure on both
young and adult epileptic patients?
References
Davies, K. S. (2011). “Formulating the evidence based practice
question: A review of the frameworks.” Evidence Based Library
and Information Practice, 6(2), 75–80. Retrieved from
https://ejournals.library.ualberta.ca/index.php/EBLIP/article/vie
wFile/9741/8144