Epileptic encephalopathies secondary to hypothalamic hamartomas treated with radiosurgery: A case series

Epileptic encephalopathies secondary to hypothalamic hamartomas treated with radiosurgery: A case series

Objective Hypothalamic hamartomas are congenital lesions that typically present with gelastic seizures, refractory epilepsy, neurodevelopmental delay, and severe cognitive impairment. Surgical procedures have been reported to be effective in removing the hamartomas, however, they are associated with...

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Published in:Epileptic disorders Vol. 26; no. 5; pp. 581 - 590
Main Authors: Jaramillo‐Jiménez, Esteban, Sandoval‐Barrios, Juliana, Walsh, Fergus John, Jaramillo‐Jiménez, María Clara, Echeverri‐Sánchez, Juan David, Rodríguez‐Márquez, Iader Alfonso, Barrientos‐Montoya, Hernán Darío, Ascencio‐Lancheros, José Luis, Giraldo‐Palacio, John Freddy, Sierra‐Arrieta, Iván Manuel, Gómez‐Duque, David Ignacio, Pérez‐López, Simón, Bustamante, Mariana Torres
Format: Journal Article
Language:English
Published: Boston, USA Wiley Periodicals, Inc 01-10-2024
Wiley Subscription Services, Inc
Subjects:
Adolescent
Child
Child, Preschool
Convulsions & seizures
Drug Resistant Epilepsy - etiology
Drug Resistant Epilepsy - surgery
encephalopathy
Epilepsy
Female
hamartoma
Hamartoma - complications
Hamartoma - surgery
Humans
Hypothalamic Diseases - complications
Hypothalamic Diseases - surgery
Hypothalamus
Male
Morbidity
Neoplasia
Neurodevelopmental disorders
Patients
Radiosurgery
Radiosurgery - methods
Seizures
Visual pathways
epilepsy
radiosurgery
encephalopathy
hamartoma
hypothalamus
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Summary:Objective Hypothalamic hamartomas are congenital lesions that typically present with gelastic seizures, refractory epilepsy, neurodevelopmental delay, and severe cognitive impairment. Surgical procedures have been reported to be effective in removing the hamartomas, however, they are associated with significant morbidity. Therefore, it is not considered a safe therapeutic modality. Image‐guided robotic radiosurgery (CyberKnife® Radiosurgery System) has been shown to provide good outcomes without lasting complications. Methods This series of cases describes the clinical, radiological, radiotherapeutic, and postsurgical outcomes of five patients with epileptic encephalopathies secondary to hypothalamic hamartomas who were treated with CyberKnife®. Results All patients exhibited refractory epilepsy with gelastic seizures and were unsuitable candidates for surgical resection The prescribed dose ranged between 16 and 25 Gy, delivered in a single fraction for four patients and five fractions for one patient while adhering strictly to visual pathway constraints. After radiosurgery, four patients maintained seizure control (one with an Engel class Ia, three with an Engel class 1d), and another presented sporadic, nondisabling gelastic seizures (with an Engel class IIa). After 24–26 months of follow‐up, in three patients, their intelligence quotient scores increased. No complications were reported. Significance This report suggests that Cyberknife may be a good option for treating hypothalamic hamartoma, particularly in cases where other noninvasive alternatives are unavailable. Nevertheless, additional studies are essential in order to evaluate the effectiveness of the technique in these cases.
Bibliography:This work has not been submitted for publication before or presented in any academic event.
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ISSN:1294-9361
1950-6945
1950-6945
DOI:10.1002/epd2.20246