Epilepsy syndromes associated with hypothalamic hamartomas.
OBJECTIVE
Hypothalamic hamartoma (HH) related epilepsy presents with gelastic seizures (GS), other seizure types and cognitive deterioration. Although seizure origin in GS has been well established, non-GS are poorly characterized. Their relationship with the HH and cognitive deterioration remains poorly understood. We analyzed seizure type, spread pattern in non-GS and their relationship with the epileptic syndrome in HH.


METHODS
We documented all current seizure types in six adult patients with HH-epilepsy with video-EEG monitoring, characterized clinical-electrographic features of gelastic and non-gelastic seizures and correlated these findings with cognitive profile, as well as MRI and ictal SPECT data.


RESULTS
Only four seizure types were seen: GS, complex partial (CPS), tonic seizures (TS) and secondarily generalized tonic-clonic seizures (sGTC). An individual patient presented either CPS or TS, but not both. GS progressed to CPS or TS, but not both. Ictal patterns in GS/TS and in GS/CPS overlapped, suggesting ictal spread from the HH to other cortical regions. Ictal SPECT patterns also showed GS/TS overlap. Patients with GS-CPS presented a more benign profile with preserved cognition and clinical-EEG features of temporal lobe epilepsy. Patients with GS-TS had clinical-EEG features of symptomatic generalized epilepsy, including mental deterioration.


CONCLUSIONS
Video-EEG and ictal SPECT findings suggest that all seizures in HH-related epilepsy originate in the HH, with two clinical epilepsy syndromes: one resembling temporal lobe epilepsy and a more catastrophic syndrome, with features of a symptomatic generalized epilepsy. The epilepsy syndrome may be determined by HH size or by seizure spread pattern.
Castro
Luiz H
LH
Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo, Brazil, Neurology, Al. Lorena, 983 apto 82, 01424-904 Sao Paulo, Brazil. castrolh@usp.br
Ferreira
Luiz K
LK
Teles
Leandro R
LR
Jorge
Carmen L
CL
Arantes
Paula R
PR
Ono
Carla R
CR
Adda
Carla C
CC
Valerio
Rosa F
RF
D000293:Adolescent; D000328:Adult; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006222:Hamartoma / Q000150:complications*; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications*; D008297:Male; D015899:Tomography, Emission-Computed, Single-Photon; D014741:Video Recording