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Improvement of Cognitive Function and Epilepsy After Hypothalamic Hamartoma Surgery

Summary and Comment |
September 27, 2013

Improvement of Cognitive Function and Epilepsy After Hypothalamic Hamartoma Surgery

  1. Jaime Toro, MD

Is hypothalamic hamartoma surgery of benefit for patients with cognitive decline, behavioral changes, and refractory epilepsy?

  1. Jaime Toro, MD

Hypothalamic hamartomas (HHs) are rare heterotopic masses of aberrant development of normal tissue consisting of a collection of mature neurons, glia, and fiber bundles. Patients with HHs present with a variety of neurological and endocrine disturbances. The hallmark of HHs is gelastic seizures, although other intractable seizures can occur as well. The prevalence of epilepsy due to HH is estimated at 1 to 2 per 100,000 (Neurosurg Focus 2013; 34:E6). Patients with HHs often also have behavioral disorders, precocious puberty, and progressive cognitive decline. In this study, 32 patients (age range, 3.3–39.3 years) underwent preoperative and postoperative neuropsychological evaluation. The average interval between surgery and postoperative neuropsychological testing was 23.4 months.

In the full study group, tests showed improvement in overall intelligence and in processing speed postsurgery. Memory scores did not change significantly. Improvement in intellectual functioning after surgery was more robust for patients with the greatest presurgical cognitive impairment and shortest duration of epilepsy.

Comment

Epilepsy surgery is well recognized as the treatment of choice for drug-resistant seizures associated with hypothalamic hamartomas. Although this is the largest series to date to evaluate the postsurgical cognitive functioning of patients with HH, small sample size and the large number of potential variables are limitations. New microsurgical, endoscopic, and stereotactic approaches to resect HH have led to improved results regarding the control of epileptic syndromes and behavioral, psychiatric, and neurocognitive disturbances. Early treatment of HH may be important to improve cognitive function outcomes. Antiepileptic drugs are typically ineffective in controlling HH-related seizures, and surgery may lead to a more favorable outcome.

  • Disclosures for Jaime Toro, MD at time of publication Editorial boards Multiple Sclerosis and Related Disorders

Citation(s):

Reader Comments (1)

Nathalie Saindon Other Healthcare Professional, Other, Coopérative de santé Espace-Temps

Hello, I would like to know if you have datas about long term evolution of the patient after surgery. Regressions, symptoms coming back? Etc.

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