Surgical management of hypothalamic hamartomas in patients with gelastic epilepsy

Addas, Bassam M.; Sherman, Elisabeth M. S.; Hader, Walter

doi:10.3171/foc/2008/25/9/e8

Cited by 25 publications

(23 citation statements)

References 49 publications

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“…2,5,6,11,13,18,25,26,28,30 Our case confirms that the epilepsy syndrome observed in adults with HH is different from the catastrophic epilepsy that develops in childhood. When epilepsy begins later, learning and behavioral problems are fewer, gelastic seizures are less prominent, and the epilepsy syndrome is usually restricted to 1 or 2 partial seizure types.…”

Section: Discussionsupporting

confidence: 73%

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Marras

Rizzi²,

Villani

et al. 2011

FOC

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Hypothalamic hamartomas (HHs) are developmental malformations associated with a range of neurological problems, including intractable seizures. There is increasing evidence of the epileptogenicity of the hamartoma and of the inhomogeneous distribution of the epileptic abnormalities within the malformation. The management strategy for treatment and results differ according to the insertion plane and the extension of the malformation into the hypothalamus. Cases characterized by extensive involvement of the hypothalamus are particularly challenging. The authors describe the case of a patient with drug-resistant epilepsy and a large hypothalamic hamartoma with an extensive area of attachment. The patient underwent implantation of 2 deep brain electrodes. The intraoperative recording showed a synchronous interictal epileptic discharge in the left temporal lobe and on the left side of the lesion. The patient was treated with chronic high-frequency stimulation. No side effects due to the stimulation were reported. At 18 months' follow-up, a reduction in complex partial seizure frequency was reported, but no significant reduction in overall seizure frequency was noticed (p = 0.14, t-test). The authors report on neurophysiological studies of the relationship between HH and epilepsy, and also discuss the literature on chronic high-frequency stimulation, including its rationale and the results of chronic stimulation of various targets for the treatment of drug-resistant epilepsy due to HH.

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Section: Discussionsupporting

confidence: 73%

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Marras

Rizzi²,

Villani

et al. 2011

FOC

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“…2 For those in whom the first surgery fails, further medical treatment options remain limited; at times, a second surgery may improve seizure outcome. We retrospectively reviewed our surgical cases to document the success and complications of reoperation after a failed first surgery.…”

mentioning

confidence: 99%

Repeat surgery for hypothalamic hamartoma in refractory epilepsy

Pati¹,

Abla

Rekate

et al. 2011

FOC

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Object Hypothalamic hamartomas (HHs) often cause pharmacoresistent epilepsy, incapacitating behavioral abnormalities, and cognitive decline. Surgical intervention offers the patient the best opportunity of seizure resolution, which occurs in approximately 50%–60% of patients, and improvement in both cognitive and behavioral difficulties. For those in whom the initial operation has failed, further medical treatment options remain quite limited, whereas, in some cases, a second surgery may improve seizure outcome. The authors retrospectively reviewed their surgical cases to document the success rate and complications of reoperations in patients with HHs. Methods Data were obtained from the HH epilepsy surgery database at the Barrow Neurological Institute between 2003 and 2010. Surgical treatment consisted of open and endoscopic procedures, as well as radiosurgery. Demographic details, seizure history, presurgical evaluation, and postoperative follow-up data were evaluated. Results In the last 7 years, 21 (13%) of 157 patients underwent reoperation after an initial epilepsy operation. The initial surgical approach in the 21 patients included: endoscopic (8 patients [38%]), transcallosal (8 patients [38%]), orbitozygomatic (3 patients [14%]), and radiosurgery (2 patients [10%]). Of the 8 patients who initially underwent endoscopic resection, repeat procedures included: radiosurgery in 4 (50%), an orbitozygomatic approach in 2 (25%), repeat endoscopy in 1 (12.5%), and a transcallosal approach in 1 (12.5%). Repeat procedures after an initial transcallosal resection included: endoscopic resection in 2 (25%); radiosurgery in 1 (12%); an orbitozygomatic approach in 2 (25%), and repeat transcallosal surgery in 3 (38%). Predominant seizure types that recurred after the first surgery were gelastic seizures, complex partial seizures, and tonic-clonic seizures. Magnetic resonance imaging in all patients prior to reoperation demonstrated either residual HH and/or connection with the mammillary bodies. Review of patients with more than 6 months of follow-up since the last surgery showed greater than 90% reduction in seizures in 4 patients (19%) and by 50%–90% in 10 patients (48%). Two patients were seizure free, and in 5 patients (24%) there was no change in seizure frequency. Following reoperation, none of the patients had any worsened behavioral issues such as increased rage attacks or disruptive violent behavior. New postoperative complications after reoperation included hemiparesis, thalamic stroke (asymptomatic and symptomatic), hyperphagia, and panhypopituitarism. Conclusions Reoperation should be considered in selected patients with HH in whom initial epilepsy surgery fails because more than half the patients have significant reductions in seizure.

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“…GE is considered to be typically associated with hypothalamic hamartomas; additionally, it may also arise from temporal and frontal lobe tumors [71]. Therefore, surgical removal of the tumor is recognized as the main treatment for GE [70]. According to previous literature data, the rate of seizure freedom in patients with GE undergoing surgery can result in up to 50% [70], what's worse, the gelastic seizures are often refractory to anti-epileptic medications [72].…”

Section: Refractory Gelastic Epilepsymentioning

confidence: 98%

“…Gelastic epilepsy (GE) is a clinical syndrome characterized by gelastic seizures with onset in infancy, with or without the development of multiple seizure types, and cognitive and behavioral impairment [70]. GE is considered to be typically associated with hypothalamic hamartomas; additionally, it may also arise from temporal and frontal lobe tumors [71].…”

Section: Refractory Gelastic Epilepsymentioning

confidence: 99%

Music therapy as a non-pharmacological treatment for epilepsy

Liao

Jiang

Wang

2015

Expert Review of Neurotherapeutics

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Epilepsy is one of the most common neurological diseases. Currently, the primary methods of treatment include pharmacological and surgical treatment. However, approximately one-third of patients exhibit refractory epilepsy. Therefore, a novel approach to epilepsy treatment is necessary. Several studies have confirmed that music therapy can be effective at reducing seizures and epileptiform discharges, thus providing a new option for clinicians in the treatment of epilepsy. Although the underlying mechanism of music therapy is unknown, it may be related to resonance, mirror neurons, dopamine pathways and parasympathetic activation. Large sample, multicenter, randomized double-blind and more effectively designed studies are needed for future music therapy studies.

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Surgical management of hypothalamic hamartomas in patients with gelastic epilepsy

Cited by 25 publications

References 49 publications

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Repeat surgery for hypothalamic hamartoma in refractory epilepsy

Music therapy as a non-pharmacological treatment for epilepsy

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