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Luisi C, Salimbene L, Pietrafusa N, Trivisano M, Marras CE, De Benedictis A, Chiarello D, Mercier M, Pepi C, de Palma L, Specchio N. Hypothalamic Hamartoma related epilepsy: A systematic review exploring clinical, neuropsychological, and psychiatric outcome after surgery. Epilepsy Behav 2024; 157:109846. [PMID: 38820683 DOI: 10.1016/j.yebeh.2024.109846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/02/2024]
Abstract
The post-surgical outcome for Hypothalamic Hamartoma (HH) related epilepsy in terms of seizure freedom (SF) has been extensively studied, while cognitive and psychiatric outcome has been less frequently reported and defined. This is a systematic review of English language papers, analyzing the post-surgical outcome in series of patients with HH-related epilepsy (≥5 patients, at least 6 months follow-up), published within January 2002-December 2022. SF was measured using Engel scale/equivalent scales. We looked at the outcome related to different surgical techniques, and HH types according to Delalande classification. We evaluated the neuropsychological and neuropsychiatric status after surgery, and the occurrence of post-surgical complications. Forty-six articles reporting 1318 patients were included, of which ten pediatric series. SF was reported in 686/1222 patients (56,1%). Delalande classification was reported in 663 patients from 24 studies, of which 70 were type I HH (10%), 320 were type II HH (48%), 189 were type III HH (29%) and 84 were type IV HH (13%). The outcome in term of SF was reported in 243 out of 663 patients. SF was reported in 12 of 24 type I HH (50%), 80 of 132 type II HH (60,6%), 32 of 59 type III HH (54,2%) and 12 of 28 type IV HH (42,9%). SF was reached in 129/262 (49,2%) after microsurgery, 102/199 (51,3%) after endoscopic surgery, 46/114 (40,6%) after gamma knife surgery, 245/353 (69,4%) after radiofrequency thermocoagulation, and 107/152 (70,4%) after MRI-guided laser interstitial thermal therapy. Hyperphagia/weight gain were the most reported surgical complications. Others were electrolyte alterations, diabetes insipidus, hypotiroidism, transient hyperthermia/poikilothermia. The highest percentage of memory deficits was reported after microsurgery, while hemiparesis and cranial nerves palsy were reported after microsurgery or endoscopic surgery. Thirty studies reported developmental delay/intellectual disability in 424/819 (51,7%) patients. 248/346 patients obtained a global improvement (72%), 70/346 were stable (20%), 28/346 got worse (8%). 22 studies reported psychiatric disorders in 257/465 patients (55,3%). 78/98 patients improved (80%), 13/98 remained stable (13%), 7/98 got worse (7%). Most of the patients had non-structured cognitive/psychiatric assessments. Based on the available data, the surgical management in patients with HH related epilepsy should be individualized, aiming to reach not only the best epilepsy result, but also the optimal cognitive and psychiatric outcome.
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Affiliation(s)
- Concetta Luisi
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Licia Salimbene
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Nicola Pietrafusa
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Marina Trivisano
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | | | | | - Daniela Chiarello
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Mattia Mercier
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Chiara Pepi
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Luca de Palma
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy.
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Tripathi M, Sheehan JP, Niranjan A, Ren L, Pikis S, Lunsford LD, Peker S, Samanci Y, Langlois AM, Mathieu D, Lee CC, Yang HC, Deng H, Rai A, Kumar N, Sahu JK, Sankhyan N, Deora H. Gamma Knife Radiosurgery for Hypothalamic Hamartoma: A Multi-Institutional Retrospective Study on Safety, Efficacy, and Complication Profile. Neurosurgery 2024:00006123-990000000-01280. [PMID: 38990006 DOI: 10.1227/neu.0000000000003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/23/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Gamma knife radiosurgery (GKRS) is a safe and effective treatment option for hypothalamic hamartomas (HH), but there is no consensus opinion on its timing, dosage, and follow-up. The aim of this study was to define the safety, efficacy, outcome, and complication profile of GKRS in this patient population. METHODS This retrospective multicentric study involved 39 patients with the mean age of 16 ± 14.84 years. Early seizures resulted in an earlier age of diagnosis in 97% of patients. At baseline, no endocrine abnormalities were seen in 75% of patients while 18.9% showed precocious puberty (PP). The median target volume was 0.55 cc (0.1-10.00 cc), and a median margin dose of 16 Gy (8.1-20.0 Gy) was delivered in a single session. All patients were evaluated for clinical, endocrinological, and radiological outcomes. RESULTS The median follow-up was 5 (0.1-15) years. The median target volume of the cohort was 0.55 (0.35-1.77) cc. The largest HH was of 10 cc. 24/39 (61.5%) were small HH (Regis I-III). At presentation, 94.8% patients suffered from seizures (87.18% with gelastic seizures). 7/39 patients (17.9%) were presented with both PP and epilepsy. Only one (2.6%) patient presented with PP alone. 29 patients had more than 3-year follow-up. All received ≥16 Gy targeting complete HH. 28% of patients showed regression in HH volume. Patients with Regis grade I-III and longer follow-up (>75 months) showed gradual improvement in seizures. 16/29 patients (55.2%) achieved good seizure control (Engel I/II) while 13 (44.8%) were in Engel III/IV status. Nine patients needed adjuvant treatment because of poor seizure control. Eight patients suffered from transient increase in seizures. One patient developed poikilothermia, and 2 patients developed new onset hormonal deficiency. CONCLUSION GKRS is a safe and effective modality for treatment of HH with significant improvement in seizure control with minimal disruption of endocrine profile. It provides an excellent safety, efficacy, and complication profile, especially for small HH. Latency of results and its adjuvant nature remain the areas of research and breakthroughs among contemporary treatment options.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lydia Ren
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Anne Marie Langlois
- Department of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - David Mathieu
- Department of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Cheng Chia Lee
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Huai Che Yang
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hansen Deng
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ashutosh Rai
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Narendra Kumar
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kuma Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Wei Z, Vodovotz L, Luy DD, Deng H, Niranjan A, Lunsford LD. Stereotactic radiosurgery as the initial management option for small-volume hypothalamic hamartomas with intractable epilepsy: a 35-year institutional experience and systematic review. J Neurosurg Pediatr 2023; 31:52-60. [PMID: 36272114 DOI: 10.3171/2022.9.peds22200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Young patients with hypothalamic hamartomas (HHs) often present with intractable epilepsy. Currently there are no established management guidelines for HH. The authors retrospectively reviewed their single-institution experience to delineate the role of stereotactic radiosurgery (SRS). METHODS Seven patients with HHs (4 females; median age 13.7 years, range 2.5-25 years) with no prior resection underwent SRS between 1987 and 2022. The clinical history, epilepsy profile, radiographic findings, and neurological outcomes were characterized. HH topographical types were classified according to the Régis classification. Outcome measures included Engel seizure classification, HH response, and the need for additional surgical interventions. RESULTS All patients had Engel class IV epilepsy. A Leksell Gamma Knife was used to deliver a median margin dose of 18 Gy (range 16-20 Gy) to a median hamartoma volume of 0.37 cm3 (range 0.20-0.89 cm3). Seizure reduction was confirmed in 6 patients, and 2 patients had regression of their hamartoma. Two patients underwent resection and/or laser interstitial thermal therapy after SRS. At follow-up, 1 patient was seizure free, 4 patients achieved Engel class II, 1 patient had Engel class III, and 1 patient had Engel class IV seizure outcomes. CONCLUSIONS SRS as the initial management option for HH was associated with a low risk of adverse effects. In this institutional series reviewing small-volume HHs treated with SRS, no adverse radiation effect was detected, and the majority of patients experienced seizure reduction. SRS should be considered as the first-line treatment for seizure control in patients with small-volume HHs.
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Affiliation(s)
- Zhishuo Wei
- 1School of Medicine, University of Pittsburgh Medical Center
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
| | - Lena Vodovotz
- 1School of Medicine, University of Pittsburgh Medical Center
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
| | - Diego D Luy
- 1School of Medicine, University of Pittsburgh Medical Center
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
| | - Hansen Deng
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
- 4Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
- 4Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 2Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center; and
- 4Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Lehner KR, D'Amico RS, Rahme R, Schneider JR, Privler GG, Faltings LJ, Du VX, Boockvar JA, Rekate HL, Langer DJ. Microsurgical management of complex hypothalamic hamartomas in the era of minimally invasive therapy: a case series and narrative review. World Neurosurg 2022; 160:e388-e397. [PMID: 35032713 DOI: 10.1016/j.wneu.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There has been a paradigm shift in the management of hypothalamic hamartoma (HH) from traditional microsurgical techniques to less invasive alternatives. However, large and extensive HH may fail to respond to these therapies, ultimately necessitating craniotomies. METHODS All patients who underwent microsurgical resection of a complex HH by the 2 senior authors from 2011-2021 were included. Charts were retrospectively reviewed and demographic, clinical, imaging, and outcome data were recorded. RESULTS 8 patients (mean age 7 years) were included. 2 had failed previous treatments. All 7 presented with gelastic seizures and cognitive dysfunction, 6 exhibited central precocious puberty, and 3 had behavioral problems. Mean lesion size was 21.6 mm and all had interpeduncular extension, 5 had intraventricular extension (Delalande type I: 3, type III: 4, type IV: 1). A frontotemporal orbitozygomatic (FTOZ) approach with optic nerve decompression was used in all patients, supplemented by another approach in 3 (endoscopic transventricular: 3, transcallosal: 1). Gross total resection was achieved in 6 patients and subtotal resection in 2. Transient complications occurred in 3 patients (37.5%): self-limited sodium imbalance (n=3), subdural hygroma (n=2). Permanent complications occurred in 2 patients (25%): perforator infarct (n=1), short-term memory loss (n=1). All patients experienced seizure resolution with preserved hypothalamic-pituitary axis function. After a mean follow-up of 41 months (2-66), 7 patients remain seizure-free, while 1 has rare seizures. Cognitive and behavioral symptoms improved in all patients. CONCLUSION For large HH with interpeduncular extension, microsurgery via the FTOZ approach is a safe and highly effective treatment modality.
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Affiliation(s)
- Kurt R Lehner
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Ralph Rahme
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Julia R Schneider
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Gloria G Privler
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Lukas J Faltings
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA
| | - Victor X Du
- Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA; Department of Neurosurgery, Long Island Jewish/Cohen Children's Medical Center, Hofstra/Northwell School of Medicine, Queens, NY, USA
| | - Harold L Rekate
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA; Department of Neurosurgery, Long Island Jewish/Cohen Children's Medical Center, Hofstra/Northwell School of Medicine, Queens, NY, USA
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, New York, NY, USA; Department of Neurosurgery, North Shore University Hospital, Hofstra/Northwell School of Medicine, Manhasset, NY, USA; Department of Neurosurgery, Long Island Jewish/Cohen Children's Medical Center, Hofstra/Northwell School of Medicine, Queens, NY, USA.
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Hamdi H, Albader F, Spatola G, Laguitton V, Trebuchon A, Bartolomei F, Regis J. Long-term cognitive outcome after radiosurgery in epileptic hypothalamic hamartomas and review of the literature. Epilepsia 2021; 62:1369-1381. [PMID: 33878213 DOI: 10.1111/epi.16896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Epileptic patients with hypothalamic hamartoma (HH) frequently present cognitive impairments. Surgical techniques aiming at HH can be very efficient for epilepsy relief and cognitive improvement but are also demonstrated to carry a significant risk of additional reduction in memory function in these already disabled patients. Gamma knife radiosurgery (GKS) offers an efficient minimally invasive procedure. We evaluated the effect of stereotactic radiosurgery on cognitive outcome. METHODS We designed a prospective single-center case series study. Thirty-nine epileptic patients (median age = 17 years, range = 4-50) with HH underwent preoperative and postoperative testing of intelligence quotient (IQ; all patients), including a working memory component, and other memory function testing (for patients ≥16 years old). All patients were prospectively evaluated and underwent complete presurgical and postsurgical clinical, electrophysiological, endocrinal, and visual assessments. In all patients, the postoperative assessment was performed at least 3 years after radiosurgery. We explored what variables correlate with cognitive outcome. Literature review was done for other surgical techniques and their risks for cognitive complications after surgery. RESULTS No decline was observed in intellectual ability (including working memory) after GKS, and no memory decline was seen in adults. We observed significant improvement (>1 SD in z-score) in working memory index (46%) and processing speed index (35%), as well as improvement in full-scale IQ (24%), verbal comprehension index (11%), perceptual organization index (21%), verbal learning (20%), and visual learning (33%). Before GKS, the probability of seizure cessation was higher in patients with higher cognitive performance. After GKS, the cognitive improvement was significantly higher in the seizure-free patients compared to the non-seizure-free patients. SIGNIFICANCE We found clear cognitive improvement in a high percentage of patients but importantly no significant decline in intellectual ability (including working memory) and no decline in memory in adult patients 3 years after GKS. GKS compares favorably to the other surgical techniques in terms of cognitive outcome, with similar seizure freedom.
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Affiliation(s)
- Hussein Hamdi
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France.,Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Functional Neurosurgery and Stereotaxy Unit, Neurological Surgery Department, Tanta University, Tanta, Egypt
| | - Faisal Albader
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Giorgio Spatola
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Virginie Laguitton
- Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Department of Clinical Physiology, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Agnes Trebuchon
- Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Department of Clinical Physiology, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Fabrice Bartolomei
- Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France.,Department of Clinical Physiology, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Jean Regis
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France.,Institute of Systems Neuroscience, Mixed Unit of Research 1106, National Institute of Health and Medical Research, Aix-Marseille University, Marseille, France
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Killeen Z, Bunch R, Kerrigan JF. Psychiatric comorbidity with hypothalamic hamartoma: Systematic review for predictive clinical features. Epilepsy Behav 2017. [PMID: 28636978 DOI: 10.1016/j.yebeh.2017.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We conducted a systematic review of the English-language literature to identify clinical features associated with a higher risk of psychiatric symptoms (aggression and rage behaviors) in patients with hypothalamic hamartoma (HH) and epilepsy. METHODS Two publicly-accessible databases (PubMed and Cochrane Library) were searched for Hypothalamic Hamartoma AND Epilepsy. We identified peer-reviewed original research publications (case reports or clinical series; N=19) in which clinical data was provided on an individual basis. Subjects were cohorted into those with (N=51) and without (N=68) behavioral aggression. Multiple clinical features were collated and subjected to univariate analysis to determine possible differences between these two cohorts. RESULTS The presence of aggression significantly correlated with 1) male gender, 2) younger age at time of first seizure onset, 3) the presence of intellectual disability, and 4) the presence of multiple seizure types (versus gelastic seizures only). For those patients undergoing surgical treatment, aggression also correlated with younger age at the time of surgical intervention. CONCLUSION Possible predictive clinical features for the presence of aggression and rage behaviors in patients with hypothalamic hamartoma and epilepsy are identified. These results may contribute to the complex treatment decisions that are unique to this population.
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Affiliation(s)
- Zachary Killeen
- University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Raymond Bunch
- Division of Psychiatry and Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - John F Kerrigan
- Division of Pediatric Neurology and Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.
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Wagner K, Schulze-Bonhage A, Urbach H, Trippel M, Spehl TS, Buschmann F, Metternich B, Ofer I, Meyer PT, Frings L. Reduced glucose metabolism in neocortical network nodes remote from hypothalamic hamartomas reflects cognitive impairment. Epilepsia 2017; 58 Suppl 2:41-49. [DOI: 10.1111/epi.13757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Kathrin Wagner
- Epilepsy Center; Medical Center - University of Freiburg; Freiburg Germany
| | | | - Horst Urbach
- Department of Neuroradiology; Medical Center - University of Freiburg; Freiburg Germany
| | - Michael Trippel
- Department of Stereotactic and Functional Neurosurgery; Medical Center - University of Freiburg; Freiburg Germany
| | - Timo S. Spehl
- Department of Nuclear Medicine; Medical Center - University of Freiburg; Freiburg Germany
| | | | | | - Isabell Ofer
- Epilepsy Center; Medical Center - University of Freiburg; Freiburg Germany
| | - Philipp T. Meyer
- Department of Nuclear Medicine; Medical Center - University of Freiburg; Freiburg Germany
| | - Lars Frings
- Department of Nuclear Medicine; Medical Center - University of Freiburg; Freiburg Germany
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Régis J, Helen Cross J, Kerrigan JF. Achieving a cure for hypothalamic hamartomas: a Sisyphean quest? Epilepsia 2017; 58 Suppl 2:7-11. [DOI: 10.1111/epi.13773] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Jean Régis
- Inserm UMR1106; Aix-Marseille University; Marseille France
- Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit; Timone University Hospital; Marseille France
| | - J. Helen Cross
- The Prince of Wales's Chair of Childhood Epilepsy; UCL-Institute of Child Health; Great Ormond Street Hospital for Children; London United Kingdom
- Young Epilepsy; Lingfield United Kingdom
| | - John F. Kerrigan
- Pediatric Neurology Division and Hypothalamic Hamartoma Program; Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix Arizona U.S.A
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9
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Wagner K, Wethe JV, Schulze-Bonhage A, Trippel M, Rekate H, Prigatano GP, Kerrigan JF. Cognition in epilepsy patients with hypothalamic hamartomas. Epilepsia 2017; 58 Suppl 2:85-93. [DOI: 10.1111/epi.13759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Kathrin Wagner
- Epilepsy Centre; Medical Center - University of Freiburg; Freiburg Germany
| | - Jennifer V. Wethe
- Division of Psychology; Mayo Clinic College of Medicine; Scottsdale Arizona U.S.A
| | | | - Michael Trippel
- Department of Stereotactic and Functional Neurosurgery; Medical Center - University of Freiburg; Freiburg Germany
| | - Harold Rekate
- The Chiari Institute; Neurosurgery; Great Neck New York U.S.A
| | - George P. Prigatano
- Department of Clinical Neuropsychology; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - John F. Kerrigan
- Division of Neurology; Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix Arizona U.S.A
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Régis J, Lagmari M, Carron R, Hayashi M, McGonigal A, Daquin G, Villeneuve N, Laguitton V, Bartolomei F, Chauvel P. Safety and efficacy of Gamma Knife radiosurgery in hypothalamic hamartomas with severe epilepsies: A prospective trial in 48 patients and review of the literature. Epilepsia 2017; 58 Suppl 2:60-71. [DOI: 10.1111/epi.13754] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Jean Régis
- Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Medhi Lagmari
- Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Romain Carron
- Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Motohiro Hayashi
- Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Aileen McGonigal
- Clinical Physiology Department; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Géraldine Daquin
- Clinical Physiology Department; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Nathalie Villeneuve
- Clinical Physiology Department; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Virginie Laguitton
- Clinical Physiology Department; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Fabrice Bartolomei
- Clinical Physiology Department; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
| | - Patrick Chauvel
- Clinical Physiology Department; INSERM, UMR 1106 and Timone University Hospital; Aix-Marseille University; Marseille France
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