title: The benign spectrum of hypothalamic hamartomas: infrequent epilepsy and normal cognition in patients presenting with central precocious puberty.
abstract: OBJECTIVE
  Hypothalamic hamartoma (HH) is the main structural cause of central precocious puberty (CPP). HH is frequently associated with cognitive impairment and epileptic encephalopathies. Disease severity in case series from neurology services may be biased towards more neurologically impaired patients.
  
  
  OBJECTIVE
  To perform a prospective cognitive evaluation in patients with HH presenting with CPP in an endocrinology outpatient clinic setting.
  
  
  METHODS
  We evaluated fifteen consecutive patients with CPP due to HH presenting to an endocrinology outpatient clinic. CPP was diagnosed at a median age of 0.7 yr (0.4-7 yr). Mean age at neurologic evaluation was 13.9 yrs. Eight patients (53.3%) were male. Epileptic seizures occurred in 5/15 (33%) patients. Two patients presented a single unprovoked seizure (SUS). Three patients were diagnosed with epilepsy. Cognitive evaluation, using age-appropriate Wechsler Intelligence Scale, was performed in 11 patients.
  
  
  RESULTS
  All patients without epilepsy, including two patients with a history of a SUS, had normal neurologic and cognitive evaluation. Epilepsy and SUS were only seen in patients with sessile HH. Three patients with epilepsy presented cognitive or behavioral findings. Reduced intelligence quotients (IQ), in the borderline range, were noted in both patients with epilepsy who underwent full cognitive evaluation. We found no significant correlation between HH diameter or shape and mean full-scale IQ.
  
  
  CONCLUSIONS
  Patients who presented with isolated CPP without epilepsy displayed normal cognition when evaluated after a mean period of 13 years. Occurrence of epilepsy, seen in a minority of patients, but not of a single seizure, was associated with mild cognitive deficit and behavioral disturbances in this case series.
authors.affiliation: Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo e Laboratório de Hormônios de Genética Molecular LIM/42, São Paulo, Brazil. p.cukier@gmail.com
authors.forename: Priscilla
authors.initials: P
authors.lastname: Cukier
authors.forename: Luiz Henrique Martins
authors.initials: LH
authors.lastname: Castro
authors.forename: Natalie
authors.initials: N
authors.lastname: Banaskiwitz
authors.forename: Leandro Roberto
authors.initials: LR
authors.lastname: Teles
authors.forename: Luiz Roberto Kobuti
authors.initials: LR
authors.lastname: Ferreira
authors.forename: Carla Cristina
authors.initials: CC
authors.lastname: Adda
authors.forename: Claudia
authors.initials: C
authors.lastname: da Costa Leite
authors.forename: Ivo J P
authors.initials: IJ
authors.lastname: Arnhold
authors.forename: Berenice Bilharinho
authors.initials: BB
authors.lastname: Mendonca
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: Latronico
authors.forename: Vinicius Nahime
authors.initials: VN
authors.lastname: Brito
mesh_terms: D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology*; D005260:Female; D006222:Hamartoma / Q000150:complications*; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications*; D007223:Infant; D007361:Intelligence Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011629:Puberty, Precocious / Q000175:diagnosis* / Q000209:etiology*; D018709:Statistics, Nonparametric