1
|
Alomari SO, Houshiemy MNE, Bsat S, Moussalem CK, Allouh M, Omeis IA. Hypothalamic hamartomas: A comprehensive review of the literature - Part 1: Neurobiological features, clinical presentations and advancements in diagnostic tools. Clin Neurol Neurosurg 2020; 197:106076. [PMID: 32717559 DOI: 10.1016/j.clineuro.2020.106076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
Hypothalamic hamartomas (HH) are rare, non-neoplastic heterotopic tissues which contains normal neurons and glia including oligodendrocytes and fibrillary astrocytes but in an abnormal distribution. They arise from the floor of the third ventricle, tuber cinereum, or mammillary bodies. Estimated incidence ranges from 1 in 50,000-1 in 1,000,000. Hypothalamic hamartomas are associated with different clinical presentations including various types of seizures, most characteristically; the gelastic seizures, precocious puberty, cognitive impairment, and behavioral changes. In this review, the authors discuss advancements in different diagnostic elements of hypothalamic hamartoma; including clinical features, EEG findings, and neuroimaging techniques. Moreover, different classifications described in the literature will be discussed.
Collapse
Affiliation(s)
- Safwan O Alomari
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Mohammed N El Houshiemy
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Shadi Bsat
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Charbel K Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Mohammed Allouh
- Anatomy Department, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Ibrahim A Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Lebanon.
| |
Collapse
|
2
|
Jayalakshmi S, Reddy R, Vadapalli R, Vooturi S, Panigrahi M. Gelastic seizures due to inferior frontal gyrus cavernoma. Neurol India 2018; 66:1503-1505. [PMID: 30233036 DOI: 10.4103/0028-3886.241351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Rajesh Reddy
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Rammohan Vadapalli
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| |
Collapse
|
3
|
Gelastic seizures caused by subtle focal cortical dysplasia in the inferior frontal gyrus: Three case reports. J Neurol Sci 2017; 376:140-142. [DOI: 10.1016/j.jns.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/12/2017] [Accepted: 03/07/2017] [Indexed: 11/22/2022]
|
4
|
Zubkov S, Del Bene VA, MacAllister WS, Shepherd TM, Devinsky O. Disabling amnestic syndrome following stereotactic laser ablation of a hypothalamic hamartoma in a patient with a prior temporal lobectomy. EPILEPSY & BEHAVIOR CASE REPORTS 2015; 4:60-2. [PMID: 26288758 PMCID: PMC4536301 DOI: 10.1016/j.ebcr.2015.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/04/2015] [Indexed: 11/18/2022]
Abstract
A 19-year-old man with cortical dysplasia and intractable focal seizures underwent a right temporal lobectomy. A hypothalamic hamartoma was subsequently recognized, and he then underwent MRI-guided stereotactic laser ablation. Unfortunately, he sustained damage to the bilateral medial mammillary bodies and suffered significant memory loss. We review laser ablation therapy for hypothalamic hamartomas and the anatomy of the memory network. We postulate that his persistent memory disorder resulted from a combination of the right temporal lobectomy and injury to the bilateral medial mammillary bodies.
Collapse
Affiliation(s)
- Sarah Zubkov
- NYU Langone Medical Center, New York, NY 10016, USA
| | - Victor A. Del Bene
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA
| | | | | | - Orrin Devinsky
- NYU Langone Medical Center, New York, NY 10016, USA
- Corresponding author at: Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, USA. Tel.: + 1 646 558 0800; fax: + 1 646 385 7164.
| |
Collapse
|
5
|
Tran TPY, Truong VT, Wilk M, Tayah T, Bouthillier A, Mohamed I, Nguyen DK. Different localizations underlying cortical gelastic epilepsy: case series and review of literature. Epilepsy Behav 2014; 35:34-41. [PMID: 24798408 DOI: 10.1016/j.yebeh.2014.03.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gelastic seizures (GS) are classically observed with hypothalamic hamartomas but they can also be associated with cortical epileptogenic foci. OBJECTIVE To study the different cortical localizations associated with GS. METHODS We reviewed the data from all patients with cortical GS investigated in our epilepsy unit from 1974 to 2012 and in the literature from 1956 to 2013. RESULTS Sixteen cases were identified in our database and 77 in the literature. Investigations provided confident focus localization in 9 and 18, respectively. In our series, the identified foci were located in the mesial temporal structures (2 left, 1 right), lateral temporal cortex (1 right), superior frontal gyrus (1 left), and operculoinsular region [3 right (orbitofrontal or frontal operculum extending into the anterior insula) and 1 left (frontal operculum extending into the anterior insula)]. In the literature, the identified foci (13 right/5 left) were located in the temporal lobe of 4 (1 right inferior, 1 right medial and inferior, 1 right posterior middle, inferior extending posteriorly to the lingual gyrus, and 1 left middle, inferior, and medial), in the frontal lobe of 12 [10 (6 right/4 left) medial (i.e., superior, medial frontal, and/or anterior cingulate gyri), 1 lateral (right anterior inferior frontal gyrus), and 1 right medioposterior orbitofrontal cortex] and in the parietal lobe of 2 (1 left superior parietal lobule and 1 right parietal operculum) patients. CONCLUSION Ictal laughter is a poorly lateralizing and localizing feature as it may be encountered in patients with a focus in the left or right frontal, temporal, parietal, or insular lobe.
Collapse
Affiliation(s)
- Thi Phuoc Yen Tran
- Division of Neurology, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame), Montreal, QC, Canada
| | - Van Tri Truong
- Division of Neurosurgery, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame), Montreal, QC, Canada
| | - Maxym Wilk
- Division of Neurology, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame), Montreal, QC, Canada
| | - Tania Tayah
- Division of Neurology, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame), Montreal, QC, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame), Montreal, QC, Canada
| | - Ismail Mohamed
- Department of Paediatrics, IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Dang Khoa Nguyen
- Division of Neurology, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame), Montreal, QC, Canada.
| |
Collapse
|
6
|
Lauterbach EC, Cummings JL, Kuppuswamy PS. Toward a more precise, clinically—informed pathophysiology of pathological laughing and crying. Neurosci Biobehav Rev 2013; 37:1893-916. [PMID: 23518269 DOI: 10.1016/j.neubiorev.2013.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 03/01/2013] [Accepted: 03/11/2013] [Indexed: 12/11/2022]
|
7
|
Vadera S, Jehi L, Burgess RC, Shea K, Alexopoulos AV, Mosher J, Gonzalez-Martinez J, Bingaman W. Correlation between magnetoencephalography-based “clusterectomy” and postoperative seizure freedom. Neurosurg Focus 2013; 34:E9. [DOI: 10.3171/2013.4.focus1357] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
During the presurgical evaluation of patients with medically intractable focal epilepsy, a variety of noninvasive studies are performed to localize the hypothetical epileptogenic zone and guide the resection. Magnetoencephalography (MEG) is becoming increasingly used in the clinical realm for this purpose. No investigators have previously reported on coregisteration of MEG clusters with postoperative resection cavities to evaluate whether complete “clusterectomy” (resection of the area associated with MEG clusters) was performed or to compare these findings with postoperative seizure-free outcomes.
Methods
The authors retrospectively reviewed the charts and imaging studies of 65 patients undergoing MEG followed by resective epilepsy surgery from 2009 until 2012 at the Cleveland Clinic. Preoperative MEG studies were fused with postoperative MRI studies to evaluate whether clusters were within the resected area. These data were then correlated with postoperative seizure freedom.
Results
Sixty-five patients were included in this study. The average duration of follow-up was 13.9 months, the mean age at surgery was 23.1 years, and the mean duration of epilepsy was 13.7 years. In 30 patients, the main cluster was located completely within the resection cavity, in 28 it was completely outside the resection cavity, and in 7 it was partially within the resection cavity. Seventy-four percent of patients were seizure free at 12 months after surgery, and this rate decreased to 60% at 24 months. Improved likelihood of seizure freedom was seen with complete clusterectomy in patients with localization outside the temporal lobe (extra–temporal lobe epilepsy) (p = 0.04).
Conclusions
In patients with preoperative MEG studies that show clusters in surgically accessible areas outside the temporal lobe, we suggest aggressive resection to improve the chances for seizure freedom. When the cluster is found within the temporal lobe, further diagnostic testing may be required to better localize the epileptogenic zone.
Collapse
Affiliation(s)
| | - Lara Jehi
- 2Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Katherine Shea
- 2Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - John Mosher
- 2Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | |
Collapse
|
8
|
Mittal S, Mittal M, Montes JL, Farmer JP, Andermann F. Hypothalamic hamartomas. Part 1. Clinical, neuroimaging, and neurophysiological characteristics. Neurosurg Focus 2013; 34:E6. [DOI: 10.3171/2013.3.focus1355] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hypothalamic hamartomas are uncommon but well-recognized developmental malformations that are classically associated with gelastic seizures and other refractory seizure types. The clinical course is often progressive and, in addition to the catastrophic epileptic syndrome, patients commonly exhibit debilitating cognitive, behavioral, and psychiatric disturbances. Over the past decade, investigators have gained considerable knowledge into the pathobiological and neurophysiological properties of these rare lesions. In this review, the authors examine the causes and molecular biology of hypothalamic hamartomas as well as the principal clinical features, neuroimaging findings, and electrophysiological characteristics. The diverse surgical modalities and strategies used to manage these difficult lesions are outlined in the second article of this 2-part review.
Collapse
Affiliation(s)
- Sandeep Mittal
- 1Department of Neurosurgery, Comprehensive Epilepsy Center, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Monika Mittal
- 1Department of Neurosurgery, Comprehensive Epilepsy Center, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | | | | | - Frederick Andermann
- 3Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| |
Collapse
|