Motor System Reorganization After Pediatric Hemispherectomy: Mechanisms, Predictors, Imaging, and Neurorehabilitation Implications

Hemispherectomy (HS) is recognized as a highly effective surgical intervention for pediatric patients with refractory epilepsy. After surgery, seizures are not only effectively controlled, but improvements in gross and fine motor functions of the contralateral limbs are also observed in some patients. This phenomenon underscores the remarkable neural plasticity, whereby the contralateral hemisphere demonstrates functional reorganization and advancement postoperatively. The present literature review synthesizes prior studies on motor function recovery after HS in patients with refractory epilepsy, elucidating the mechanisms by which postoperative motor functions are sustained by the contralateral hemisphere. Key factors influencing postoperative motor outcomes are highlighted, including age at surgery and underlying etiology, with particular emphasis on the critical role of white matter tracts originating from the ipsilateral cortex in facilitating motor compensation after surgery. This review seeks to advance comprehension of the inherent mechanisms underlying neural plasticity in the human cerebral hemispheres, offering valuable insights into the reorganization of the postoperative motor system.