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Metodiev D, Minkin K, Ruseva M, Ganeva R, Parvanov D, Nachev S. Pathomorphological Diagnostic Criteria for Focal Cortical Dysplasias and Other Common Epileptogenic Lesions—Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13071311. [PMID: 37046529 PMCID: PMC10092959 DOI: 10.3390/diagnostics13071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Focal cortical dysplasia (FCD) represents a heterogeneous group of morphological changes in the brain tissue that can predispose the development of pharmacoresistant epilepsy (recurring, unprovoked seizures which cannot be managed with medications). This group of neurological disorders affects not only the cerebral cortex but also the subjacent white matter. This work reviews the literature describing the morphological substrate of pharmacoresistant epilepsy. All illustrations presented in this study are obtained from brain biopsies from refractory epilepsy patients investigated by the authors. Regarding classification, there are three main FCD types, all of which involve cortical dyslamination. The 2022 revision of the International League Against Epilepsy (ILAE) FCD classification includes new histologically defined pathological entities: mild malformation of cortical development (mMCD), mild malformation of cortical development with oligodendroglial hyperplasia in frontal lobe epilepsy (MOGHE), and “no FCD on histopathology”. Although the pathomorphological characteristics of the various forms of focal cortical dysplasias are well known, their aetiologic and pathogenetic features remain elusive. The identification of genetic variants in FCD opens an avenue for novel treatment strategies, which are of particular utility in cases where total resection of the epileptogenic area is impossible.
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Lu C, Wang K, Meng F, Wang Y, Shan Y, Wei P, Zhao G. 18F-FDG-PET glucose hypometabolism pattern in patients with epileptogenic hypothalamic hamartoma. Front Med 2021; 15:913-921. [PMID: 34811641 DOI: 10.1007/s11684-021-0874-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022]
Abstract
Epileptogenic hypothalamic hamartoma is characterized by intractable gelastic seizures. A systematic analysis of the overall brain metabolic pattern in patients with hypothalamic hamartoma (HH) could facilitate the understanding of the epileptic brain network and the associated brain damage effects of HH. In this study, we retrospectively evaluated 27 patients with epileptogenic HH (8 female patients; age, 2-33 years) by using 18F-fluorodeoxyglucose-positron emission tomography. The correlations among tomography result, seizure type, sex, and structural magnetic resonance imaging were assessed. Whole metabolic patterns and voxel-based morphometry findings were assessed by group analysis with healthy controls. Assessment of the whole metabolic pattern in patients with HH revealed several regional metabolic reductions in the cerebrum and an overall metabolic reduction in the cerebellum. In addition, areas showing hypometabolism in the neocortex were more widely distributed ipsilaterally than contralaterally to the HH. Reductions in glucose metabolism and gray matter volume in the neocortex were predominant ipsilateral to the HH. In conclusion, the glucose hypometabolism pattern in patients with epileptogenic HH involved the neocortex, subcortical regions, and cerebellum. The characteristics of glucose hypometabolism differed across seizure type and sex. Reductions in glucose metabolism and structural changes may be based on different mechanisms, but both are likely to occur ipsilateral to the HH in the neocortex. We hypothesized that the dentato-rubro-thalamic tract and cerebro-ponto-cerebellar tract, which are responsible for intercommunication between the cerebral cortex, subcortical regions, and cerebellar regions, may be involved in a pathway related to seizure propagation, particularly gelastic seizures, in patients with HH.
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Affiliation(s)
- Chao Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Fei Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China. .,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China.
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China. .,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China. .,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China. .,Center of Epilepsy, Beijing Institute for Brain Disorder, Beijing, 100069, China.
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Yang YF, Wei PH, Meng F, An Y, Fan XT, Wang YH, Wang D, Ren LK, Shan YZ, Zhao GG. Glucose Metabolism Characteristics of Extra-Hypothalamic Cortex in Patients With Hypothalamic Hamartomas (HH) Undergoing Epilepsy Evaluation: A Retrospective Study of 16 Cases. Front Neurol 2021; 11:587622. [PMID: 33519673 PMCID: PMC7840884 DOI: 10.3389/fneur.2020.587622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose: There are few studies on the glucose metabolic characteristics of the extra-hypothalamic cortex in the hypothalamic hamartomas (HH). A comprehensive understanding of pathogenic progression of the disease is required from the perspective of cortical metabolism; therefore, we aimed to characterize metabolic characteristics of extra-hypothalamic in HH patients. Methods: We investigated the metabolic characteristics of 16 HH patients, all of whom underwent epilepsy evaluation at Xuan Wu Hospital between 2017 and 2019. The lateralization and cortical distribution pattern of hypometabolism was assessed and related to HH mass neuroanatomy on magnetic resonance imaging (MRI) as well as scalp-electroencephalogram (scalp-EEG) abnormalities. Furthermore, asymmetry measurements of region of interest (ROI) in the temporal cortex (hippocampal formation, amygdala, and lateral temporal neocortex) were quantitatively assessed based on the normalized average positron emission tomography (PET) voxel values. The surgery prognosis was assessed using the International League Against Epilepsy (ILAE) classification system. Results: The lateralization of hypometabolism in global visual ratings was consistent with the HH mass lateralization seen on MRI. Cortical hypometabolism showed three patterns depending whether the HH mass involved mammillary bodies, middle hypothalamus nucleus, or both. The three patterns were hypometabolism of the mesial temporal cortex with symptom of mesial temporal epilepsy (3/16, pattern I), lateral temporal, and extratemporal (frontal or parietal) cortex with symptom of neocortex temporal or frontal epilepsy (5/16, pattern II), and mesial and lateral temporal cortex and extratemporal (frontal or parietal) cortex with varied symptoms (8/16, pattern III), respectively. A significant difference in PET voxel values was found between bilateral hippocampal formation (P = 0.001) and lateral temporal neocortex in the third group (P = 0.005). We suggest that the hypometabolic characteristics of the extra-hypothalamic cortex in HH patients have three patterns. The final cortical hypometabolic pattern depends on the neuroanatomic location of the HH mass and was consistent with the main involved cortex of the interictal and ictal discharges. The third hypometabolic pattern with the most extensive cortical hypometabolism has a poorer prognosis.
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Affiliation(s)
- Yan-Feng Yang
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Fei Meng
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yang An
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xiao-Tong Fan
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yi-He Wang
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Di Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Lian-Kun Ren
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yong-Zhi Shan
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Guo-Guang Zhao
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
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Scholly J, Bartolomei F. Gelastic seizures and the hypothalamic hamartoma syndrome: Epileptogenesis beyond the lesion? HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:143-154. [PMID: 34266589 DOI: 10.1016/b978-0-12-819973-2.00010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The clinicoradiologic syndrome of hypothalamic hamartoma (HH) manifests with a variety of symptoms, including pharmacoresistant epilepsy with multiple seizure types, precocious puberty, behavioral disturbances, and cognitive impairment. Gelastic seizures are an early marker of epilepsy with HH in most of the cases. Despite a high variability, two major epilepsy phenotypes can be distinguished, based on electroclinical features: (i) focal seizures with epigastric or déjà-vu aura, loss of consciousness, and oroalimentary or gestural automatisms suggestive of temporal lobe involvement; and (ii) motor seizures with tonic, atonic, myoclonic, or versive phenomena, suggesting frontoparietal network involvement, with possible evolution toward an epileptic encephalopathy. The underlying physiopathologic mechanisms are not completely elucidated. The well-known intrinsic epileptogenicity of the HH represents the rationale for direct HH-aiming surgical procedures, with variable success in achieving seizure freedom. The concept of kindling-like secondary epileptogenesis has been suggested as a possible putative mechanism since the very beginnings of the hamartocentric era. Accordingly, a cortical area with enhanced epileptogenic properties due to an independent stage of secondary epileptogenesis would be responsible for seizures persisting after hamartoma ablation. However, recent intracerebral stereotactic EEG (SEEG) explorations demonstrated more complex, both reciprocal and hierarchical, relationships within the hypothalamo-cortical epileptogenic networks. Network formation may be due to either secondary epileptogenesis or widespread epileptogenicity present at the outset. A short time window from epilepsy onset to surgery seems to be crucial to cure epilepsy by direct surgery addressing a hamartoma. SEEG exploration may be reasonably proposed in cases where clinical data suggest an extension of the epileptogenic zone outside the limits of the HH, especially in focal seizures with impaired awareness and absence of gelastic seizures, or after a failure of the direct HH-aiming procedure.
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Affiliation(s)
- Julia Scholly
- Department of Epileptology and Cerebral Rhythmology, Aix Marseille University, Hôpital Timone, Marseille, France; Center for Magnetic Resonance in Biology and Medicine, Aix Marseille University, Hôpital Timone, Marseille, France
| | - Fabrice Bartolomei
- Department of Epileptology and Cerebral Rhythmology, Aix Marseille University, Hôpital Timone, Marseille, France; Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France.
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Shirozu H, Masuda H, Kameyama S. Significance of the electrophysiological border between hypothalamic hamartomas and the hypothalamus for the target of ablation surgery identified by intraoperative semimicrorecording. Epilepsia 2020; 61:2739-2747. [PMID: 33084060 DOI: 10.1111/epi.16730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Ablation surgery has become the first line of treatment for hypothalamic hamartomas (HHs). For effective treatment, optimum targeting of ablation is mandatory. The present study aimed to evaluate the correspondence between the electrophysiological features of HHs and morphological targeting by semimicrorecording during stereotactic radiofrequency thermocoagulation (SRT). METHODS Eighty HH patients who underwent SRT were involved. Semimicrorecording was performed on the first trajectory. The distance from the center of the target at the morphological border (TMB) determined by magnetic resonance imaging, differences in discharge patterns, and area potentials (APs) were measured. RESULTS The electrophysiological border (EB) between the HH and hypothalamus was detected by semimicrorecording in 73 (91.3%), AP increase (API) in the HH was detected in 31 (38.8%), and spike discharges (SDs) of the HH were detected in 56 patients (70.0%). Semimicrorecording showed significantly different APs among structures passing through the trajectory, except between API and SDs. The median distances from the center of the TMB to the EB, API, SDs, and AP decline were -3.50, -2.49, -1.38, and +2.00 mm, respectively. SIGNIFICANCE The electrophysiological features of HHs were shown by semimicrorecording during SRT. The EB corresponded to the morphological border. The electrophysiologically active area of HHs was located near the border. Ablation surgery should focus on disconnection at the border between the HH and the hypothalamus to maximize its effectiveness, as well as to reduce complications.
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Affiliation(s)
- Hiroshi Shirozu
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Hiroshi Masuda
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Shigeki Kameyama
- Department of Neurosurgery, Niigata Seiro Hospital, Niigata, Japan
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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.
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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.
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Liu Z, Luan G, Yang C, Guan Y, Liu C, Wang J, Wang M, Wang Q. Distinguishing Dependent-Stage Secondary Epileptogenesis in a Complex Case of Giant Hypothalamic Hamartoma With Assistance of a Computational Method. Front Neurol 2020; 11:478. [PMID: 32587568 PMCID: PMC7297952 DOI: 10.3389/fneur.2020.00478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/01/2020] [Indexed: 11/18/2022] Open
Abstract
Besides gelastic seizures, hypothalamic hamartoma (HH) is also noted for its susceptibility to remote secondary epileptogenesis. Although clinical observations have demonstrated its existence, and a three-stage theory has been proposed, how to determine whether a remote symptom is spontaneous or dependent on epileptic activities of HH is difficult in some cases. Herein, we report a case of new non-gelastic seizures in a 9-year-old female associated with a postoperatively remaining HH. Electrophysiological examinations and stereo-electroencephalography (SEEG) demonstrated seizure onsets with slow-wave and fast activities on the outside of the HH. By using computational methodologies to calculate the network dynamic effective connectivities, the importance of HH in the epileptic network was revealed. After SEEG-guided thermal coagulation of the remaining HH, the patient finally was seizure-free at the 2-year follow-up. This case showed the ability of computational methods to reveal information underlying complex SEEG signals, and further demonstrated the dependent-stage secondary epileptogenesis, which has been rarely reported.
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Affiliation(s)
- Zhao Liu
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Chuanzuo Yang
- Department of Dynamics and Control, Beihang University, Beijing, China
| | - Yuguang Guan
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Changqing Liu
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Qingyun Wang
- Department of Dynamics and Control, Beihang University, Beijing, China
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Wang S, Zhao M, Li T, Zhang C, Zhou J, Wang M, Wang X, Liu Z, Ma K, Luan G, Guan Y. Stereotactic radiofrequency thermocoagulation and resective surgery for patients with hypothalamic hamartoma. J Neurosurg 2020; 134:1019-1026. [PMID: 32302977 DOI: 10.3171/2020.2.jns193423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/13/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In this study, the authors compared the efficacy and safety of stereotactic radiofrequency thermocoagulation (SRT) and resective surgery (RS) for patients with hypothalamic hamartoma (HH). METHODS The authors included all patients with HHs who were treated by SRT or hamartoma resection. Seizure outcomes were assessed by blinded observers according to the International League Against Epilepsy (ILAE) classification. Favorable seizure outcomes were defined as ILAE classes 1 and 2, and unfavorable seizure outcomes were defined as ILAE classes 3-6. RESULTS Twenty-nine patients who underwent SRT or RS met the inclusion criteria; 3 were excluded because they had completed less than 12 months of follow-up. Most of the patients (20 of 26; 76.9%) had small HHs (i.e., maximum HH diameter less than 20 mm). The patients' follow-up time ranged from 12 to 66 months (median 60 months). At the last follow-up, favorable outcomes were observed in 9 patients (69.2%) who had undergone SRT and 10 patients (76.9%) who had undergone HH resection. No significant difference was found in seizure outcomes between SRT and RS recipients. Patients with giant HHs were more likely than patients with smaller tumors to undergo multiple resections (p = 0.043, univariate logistic regression; significant). However, no significant difference was found between SRT and RS recipients in terms of the number of procedures per patient. SRT recipients had fewer and less-severe adverse events than RS recipients. CONCLUSIONS For patients with small HHs, SRT provides similar seizure outcomes to RS with a less invasive procedure. Patients who underwent SRT experienced fewer and lighter adverse effects than patients who had RS. Patients with giant HHs were more likely to undergo multiple HH resections.
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Affiliation(s)
| | | | - Tianfu Li
- 2Neurology, SanBo Brain Hospital, Capital Medical University, Beijing.,3Beijing Key Laboratory of Epilepsy, Beijing; and.,4Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | | | - Jian Zhou
- Departments of1Neurosurgery and.,3Beijing Key Laboratory of Epilepsy, Beijing; and.,4Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Mengyang Wang
- 2Neurology, SanBo Brain Hospital, Capital Medical University, Beijing
| | - Xiongfei Wang
- Departments of1Neurosurgery and.,3Beijing Key Laboratory of Epilepsy, Beijing; and.,4Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | | | | | - Guoming Luan
- Departments of1Neurosurgery and.,3Beijing Key Laboratory of Epilepsy, Beijing; and.,4Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Yuguang Guan
- Departments of1Neurosurgery and.,3Beijing Key Laboratory of Epilepsy, Beijing; and.,4Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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Conde Blanco E, Anciones Martín C, Manzanares I, Gil López F, Roldán P, Donaire A, Rumiá J, Carreño M. Hypothalamic hamartomas in adulthood: Clinical spectrum and treatment outcome-A unicenter experience. Brain Behav 2019; 9:e01412. [PMID: 31578831 PMCID: PMC6851795 DOI: 10.1002/brb3.1412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/28/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Clinical manifestations of the hypothalamic hamartoma-epilepsy syndrome (HH-ES) in adulthood are variable. Efficacy of therapeutic options and outcome are diverse. METHODS Retrospective study of adult patients diagnosed with a HH in magnetic resonance imaging and epilepsy who attended our tertiary Epilepsy Unit between 2003 and 2018. We report the clinical and electroencephalographic features of a series of adult patients with HH and related epilepsy seen in our center together with the treatments and seizure outcome. RESULTS We describe a series of eight patients. Five males (62.5%), median age at evaluation was 28.5 years (IQR: 15.5). Clinical manifestations included focal with preserved and impaired awareness emotional seizures (gelastic seizures [GS]) in six patients (75%), focal tonic, atonic with impaired awareness and focal to bilateral tonic-clonic seizures. Mild GS were the only symptom in one patient. Three patients (37.5%) had endocrinological disturbances such as obesity and hypothyroidism. Fifty percent of the patients showed psychiatric comorbidity such as anxiety disorder and aggressiveness, and two patients had psychomotor delay. Seven patients (87.7%) had drug-resistant seizures and three of them were treated with radiosurgery. Out of the treated group, only one (33.3%) became seizure-free 2 years after surgery but developed psychiatric problems. The other two patients had an Engel IV outcome and received a vagal nerve stimulation (VNS) implant. VNS did not lead to changes either in intensity nor in seizure frequency. CONCLUSIONS Hypothalamic hamartoma-epilepsy syndrome clinical manifestations in adult patients are as variable as at pediatric age. Outcome of therapeutic options such as radiosurgery or VNS may be poorer at this stage.
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Affiliation(s)
| | | | - Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | | | - Pedro Roldán
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Jordi Rumiá
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
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van Tonder L, Burn S, Iyer A, Blair J, Didi M, Carter M, Martland T, Mallucci C, Chawira A. Open resection of hypothalamic hamartomas for intractable epilepsy revisited, using intraoperative MRI. Childs Nerv Syst 2018; 34:1663-1673. [PMID: 29752488 DOI: 10.1007/s00381-018-3786-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/27/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Hypothalamic hamartomas (HHs) are rare non-neoplastic lesions which cause drug-resistant epilepsy with associated behavioural, psychiatric and endocrine issues. With the development of new minimally invasive techniques for the treatment of HH, there is a need to reappraise the effectiveness and safety of each approach. We review the outcomes of HH patients treated surgically, utilizing intraoperative magnetic resonance imaging (IOMRI), by a team of Alder Hey NHS Foundation Trust tumour and epilepsy neurosurgeons since 2011. METHODS Patient records of all HH cases operated on since 2011 were reviewed to confirm history of presentation and clinical outcomes. RESULTS Ten patients have undergone surgery for HH under the dual care of Alder Hey tumour and epilepsy neurosurgeons during this period. Eight cases had a midline transcallosal, interforniceal approach with the remaining 2 having a transcallosal, transforaminal approach. All patients had an IOMRI scan, with 40% needing further tumour resection post-IOMRI. Forty percent had a total resection, 3 patients had near-total resection and 3 patients had subtotal resection (~ 30% tumour residual on post-operative MRI). No new neurological complications developed post-operatively. Hypothalamic axis derangements were seen in 3 cases, including 1 diabetes insipidus with hypocortisolaemia, 1 hypodipsia and 1 transient hyperphagia. Eighty percent are seizure free; the remaining two patients have had significant improvements in seizure frequency. CONCLUSIONS IOMR was used to tailor the ideal tumour resection volume safely based on anatomy of the lesion, which combined with the open transcallosal, interforniceal route performed by surgeons experienced in the approach resulted in excellent, safe and effective seizure control.
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Affiliation(s)
- Libby van Tonder
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK.
| | - Sasha Burn
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
| | - Anand Iyer
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
| | - Jo Blair
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
| | - Mohammed Didi
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
| | - Michael Carter
- Department of Neurosurgery, Bristol Royal Hospital for Children, Bristol, BS2 8BJ, UK
| | - Timothy Martland
- Department of Paediatric Neurology, Royal Manchester Children's Hospital (RMCH), Manchester, M13 9WL, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
| | - Athanasius Chawira
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
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11
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Sonoda M, Masuda H, Shirozu H, Ito Y, Akazawa K, Asano E, Kameyama S. Predictors of cognitive function in patients with hypothalamic hamartoma following stereotactic radiofrequency thermocoagulation surgery. Epilepsia 2017; 58:1556-1565. [DOI: 10.1111/epi.13838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Masaki Sonoda
- Hypothalamic Hamartoma Center; Department of Functional Neurosurgery; Nishi-Niigata Chuo National Hospital; Niigata Japan
- Department of Neurosurgery; Graduate School of Medicine; Yokohama City University; Yokohama Kanagawa Japan
| | - Hiroshi Masuda
- Hypothalamic Hamartoma Center; Department of Functional Neurosurgery; Nishi-Niigata Chuo National Hospital; Niigata Japan
| | - Hiroshi Shirozu
- Hypothalamic Hamartoma Center; Department of Functional Neurosurgery; Nishi-Niigata Chuo National Hospital; Niigata Japan
| | - Yosuke Ito
- Hypothalamic Hamartoma Center; Department of Functional Neurosurgery; Nishi-Niigata Chuo National Hospital; Niigata Japan
| | - Kohei Akazawa
- Department of Medical Informatics; Niigata University Medical and Dental Hospital; Niigata Japan
| | - Eishi Asano
- Department of Pediatrics; Children's Hospital of Michigan; Detroit Medical Center; Wayne State University; Detroit Michigan U.S.A
- Department of Neurology; Children's Hospital of Michigan; Detroit Medical Center; Wayne State University; Detroit Michigan U.S.A
| | - Shigeki Kameyama
- Hypothalamic Hamartoma Center; Department of Functional Neurosurgery; Nishi-Niigata Chuo National Hospital; Niigata Japan
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12
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Scholly J, Staack AM, Kahane P, Scavarda D, Régis J, Hirsch E, Bartolomei F. Hypothalamic hamartoma: Epileptogenesis beyond the lesion? Epilepsia 2017; 58 Suppl 2:32-40. [PMID: 28591482 DOI: 10.1111/epi.13755] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/30/2022]
Abstract
The discovery of intrinsic epileptogenicity of the hypothalamic hamartoma (HH) marked a new area in understanding the associated clinical syndrome, often manifesting as progressive epileptic encephalopathy. However, therapeutic procedures targeting the HH proved to be inefficient to cure seizures in up to 50% of cases, whereas in cases with partial improvement, the electroclinical patterns of persisting seizures suggest an involvement of distant cortical regions. The concept of kindling-like secondary epileptogenesis has been suggested as a possible underlying mechanism. Yet the role of the hypothalamic lesion in the pathophysiology of the syndrome remains debatable. In the Strasbourg-Kork series, the best outcomes were obtained when the duration of epilepsy before endoscopic HH surgery did not exceed 10 years. In two patients with HH ablation followed at a later time by a temporal lobectomy, only this second surgical step allowed complete seizure freedom. These findings suggest the existence of an independent, third stage of secondary epileptogenesis in human. In the Grenoble series, stereotactic intracerebral recordings (stereo electroencephalography [SEEG]) of five HH cases demonstrated that gelastic/dacrystic seizures were correlated with discharges within the HH, whereas other seizure types were related to discharges affecting cortical regions, which sometimes seemed to be triggered by HH. In the Marseille series, two cases explored by SEEG provided evidence of extended epileptogenicity outside the limits of the HH, forming complex epileptogenic networks, with HH still triggering clusters of neocortical seizures in the first, but not obligatory involved in spontaneous seizures in the second case. Taken together, our data argue for the existence of dynamic ictal network organization, with possible "kindling-like" relationships between the HH and the neocortex or widespread epileptogenesis. Despite the existence of secondary epileptogenesis, the epileptogenic zone could still be limited to the hamartoma, for which early surgical treatment should be pragmatically considered as a first surgical step.
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Affiliation(s)
- Julia Scholly
- Medical and Surgical Epilepsy Unit, Hautepierre Hospital, University of Strasbourg, Strasbourg, France.,Kork Epilepsy Center, Kehl-Kork, Germany
| | | | - Philippe Kahane
- Inserm U836, Grenoble, France.,University Grenoble Alpes, GIN, Grenoble, France.,Neurology Department, CHU de Grenoble, Hospital Michallon, Grenoble, France
| | - Didier Scavarda
- Aix Marseille Univ, Inserm, INS, Systems Neurosciences Institute, Marseille, France
| | - Jean Régis
- Aix Marseille Univ, Inserm, INS, Systems Neurosciences Institute, Marseille, France
| | - Edouard Hirsch
- Medical and Surgical Epilepsy Unit, Hautepierre Hospital, University of Strasbourg, Strasbourg, France.,IDEE, Institute of Epilepsies of Childhood and Adolescence, Lyon, France
| | - Fabrice Bartolomei
- Aix Marseille Univ, Inserm, INS, Systems Neurosciences Institute, Marseille, France
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13
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Kerrigan JF, Parsons A, Tsang C, Simeone K, Coons S, Wu J. Hypothalamic hamartoma: Neuropathology and epileptogenesis. Epilepsia 2017; 58 Suppl 2:22-31. [DOI: 10.1111/epi.13752] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 01/06/2023]
Affiliation(s)
- John F. Kerrigan
- Hypothalamic Hamartoma Program and Pediatric Neurology Division; Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix Children's Hospital; Phoenix Arizona U.S.A
- Hypothalamic Hamartoma Tissue Research Laboratory; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Angela Parsons
- Hypothalamic Hamartoma Tissue Research Laboratory; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Candy Tsang
- Hypothalamic Hamartoma Tissue Research Laboratory; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Kristina Simeone
- Department of Pharmacology; Creighton University School of Medicine; Omaha Nebraska U.S.A
| | - Stephen Coons
- Division of Neuropathology; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Jie Wu
- Hypothalamic Hamartoma Program and Division of Neurology; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
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14
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Du VX, Gandhi SV, Rekate HL, Mehta AD. Laser interstitial thermal therapy: A first line treatment for seizures due to hypothalamic hamartoma? Epilepsia 2017; 58 Suppl 2:77-84. [DOI: 10.1111/epi.13751] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Victor X. Du
- Northwell Health Department of Neurosurgery; Manhasset New York U.S.A
| | | | - Harold L. Rekate
- Northwell Health Department of Neurosurgery; Manhasset New York U.S.A
| | - Ashesh D. Mehta
- Northwell Health Department of Neurosurgery; Manhasset New York U.S.A
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15
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Shirozu H, Masuda H, Ito Y, Sonoda M, Kameyama S. Stereotactic radiofrequency thermocoagulation for giant hypothalamic hamartoma. J Neurosurg 2016; 125:812-821. [DOI: 10.3171/2015.6.jns15200] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE
The authors undertook this study to validate the feasibility and safety of stereotactic radiofrequency thermocoagulation (SRT) for the surgical treatment of giant hypothalamic hamartoma (HH).
METHODS
Of the 109 patients who underwent SRT for hypothalamic hamartoma (HH) at the authors' institution between 1997 and 2013, 16 patients (9 female, 7 male) had giant HHs (maximum diameter ≥ 30 mm). The clinical records of these 16 patients were retrospectively reviewed.
RESULTS
The patients' age at first SRT ranged from 1 to 22 years (median 5 years). The maximum diameter of their HHs was 30–80 mm (mean 38.5 mm). Eleven HHs had bilateral attachments to the hypothalamus. All patients had gelastic seizures (GS), and 12 had types of seizures other than GS. Some of these patients also had mental retardation (n = 10, 62.5%), behavioral disorders (n = 8, 50.0%), and precocious puberty (n = 11, 68.8%). A total of 22 SRT procedures were performed; 5 patients underwent repeat SRT procedures. There was no mortality or permanent morbidity. After 17 of the 22 procedures, the patients experienced transient complications, including high fever (n = 7), hyperphagia (n = 3), hyponatremia (n = 6), disturbance of consciousness (n = 1), cyst enlargement (n = 1), and epidural hematoma (n = 1). Thirteen patients (81.3%) achieved freedom from GS after the final SRT procedure during a follow-up period ranging from 6 to 60 months (mean 23 months). Twelve patients had nongelastic seizures in addition to GS, and 7 (58.3%) of these 12 patients experienced freedom from their nongelastic seizures.
CONCLUSIONS
SRT provided minimal invasiveness and excellent seizure outcomes even in patients with giant HHs. Repeat SRT is safe for residual GS. SRT is a feasible single surgical strategy for HH regardless of the tumor's size or shape.
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Affiliation(s)
- Hiroshi Shirozu
- 1Department of Functional Neurosurgery and
- 2Hypothalamic Hamartoma Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Hiroshi Masuda
- 1Department of Functional Neurosurgery and
- 2Hypothalamic Hamartoma Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Yosuke Ito
- 1Department of Functional Neurosurgery and
- 2Hypothalamic Hamartoma Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Masaki Sonoda
- 1Department of Functional Neurosurgery and
- 2Hypothalamic Hamartoma Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Shigeki Kameyama
- 1Department of Functional Neurosurgery and
- 2Hypothalamic Hamartoma Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
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16
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Burrows AM, Marsh WR, Worrell G, Woodrum DA, Pollock BE, Gorny KR, Felmlee JP, Watson RE, Kaufmann TJ, Goerss S, Van Gompel JJ. Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas. Neurosurg Focus 2016; 41:E8. [DOI: 10.3171/2016.7.focus16218] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging–guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT.
METHODS
An institutional review board–approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. Demographic and historical medical data, including seizure and medication histories, previous surgeries, procedural details, and surgical complications, along with radiological interpretation of the HHs, were recorded. The primary outcome was seizure freedom, and secondary outcomes included medication reduction, seizure frequency, operative morbidity, and clinical outcome at the latest follow-up.
RESULTS
All 3 patients in the multi-institutional database had developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They presented for further treatment at 25, 28, and 48 years of age, after previous treatments with stereotactic radiosurgery in all cases and partial hamartoma resection in one case. One ablation was complicated by a small tract hemorrhage, which was stable on postoperative imaging. One patient developed hyponatremia and experienced weight gain, which were respectively managed with fluid restriction and counseling. At the most recent follow-up at a mean of 21 months (range 1–32 months), one patient was seizure free while another had meaningful seizure reduction. Medication was reduced in one case.
CONCLUSIONS
Adults with gelastic seizures despite previous treatments can undergo MRg-LITT with reasonable safety and efficacy. This novel therapy may provide a minimally invasive alternative for primary and recurrent HH as the technique is refined.
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17
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Lesional cerebellar epilepsy: a review of the evidence. J Neurol 2016; 264:1-10. [PMID: 27260293 DOI: 10.1007/s00415-016-8161-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
Classical teaching in epileptology localizes the origins of focal seizures solely in the cerebral cortex, with only inhibitory effects attributed to subcortical structures. However, electrophysiological and neuroimaging studies over the last decades now provide evidence for an initiation of epileptic seizures within subcortical structures. Intrinsic epileptogenicity of hypothalamic hamartoma has already been established in recognition of subcortical epilepsy, whereas a seizure-generating impact of dysplastic cerebellar lesions remains to be clarified. Herein, we examine the supportive evidence and clinical presentation of cerebellar seizures and review therapy options.
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18
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Kameyama S, Shirozu H, Masuda H, Ito Y, Sonoda M, Akazawa K. MRI-guided stereotactic radiofrequency thermocoagulation for 100 hypothalamic hamartomas. J Neurosurg 2016; 124:1503-12. [DOI: 10.3171/2015.4.jns1582] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECT
The aim of this study was to elucidate the invasiveness, effectiveness, and feasibility of MRI-guided stereotactic radiofrequency thermocoagulation (SRT) for hypothalamic hamartoma (HH).
METHODS
The authors examined the clinical records of 100 consecutive patients (66 male and 34 female) with intractable gelastic seizures (GS) caused by HH, who underwent SRT as a sole surgical treatment between 1997 and 2013.
The median duration of follow-up was 3 years (range 1–17 years). Seventy cases involved pediatric patients. Ninety percent of patients also had other types of seizures (non-GS). The maximum diameter of the HHs ranged from 5 to 80 mm (median 15 mm), and 15 of the tumors were giant HHs with a diameter of 30 mm or more. Comorbidities included precocious puberty (33.0%), behavioral disorder (49.0%), and mental retardation (50.0%).
RESULTS
A total of 140 SRT procedures were performed. There was no adaptive restriction for the giant or the subtype of HH, regardless of any prior history of surgical treatment or comorbidities. Patients in this case series exhibited delayed precocious puberty (9.0%), pituitary dysfunction (2.0%), and weight gain (7.0%), besides the transient hypothalamic symptoms after SRT. Freedom from GS was achieved in 86.0% of patients, freedom from other types of seizures in 78.9%, and freedom from all seizures in 71.0%. Repeat surgeries were not effective for non-GS. Seizure freedom led to disappearance of behavioral disorders and to intellectual improvement.
CONCLUSIONS
The present SRT procedure is a minimally invasive and highly effective surgical procedure without adaptive limitations. SRT involves only a single surgical procedure appropriate for all forms of epileptogenic HH and should be considered in patients with an early history of GS.
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Affiliation(s)
- Shigeki Kameyama
- 1Hypothalamic Hamartoma Center, Department of Functional Neurosurgery, Nishi-Niigata Chuo National Hospital; and
| | - Hiroshi Shirozu
- 1Hypothalamic Hamartoma Center, Department of Functional Neurosurgery, Nishi-Niigata Chuo National Hospital; and
| | - Hiroshi Masuda
- 1Hypothalamic Hamartoma Center, Department of Functional Neurosurgery, Nishi-Niigata Chuo National Hospital; and
| | - Yosuke Ito
- 1Hypothalamic Hamartoma Center, Department of Functional Neurosurgery, Nishi-Niigata Chuo National Hospital; and
| | - Masaki Sonoda
- 1Hypothalamic Hamartoma Center, Department of Functional Neurosurgery, Nishi-Niigata Chuo National Hospital; and
| | - Kohei Akazawa
- 2Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
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19
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Yamada S, Wood CP, Shah JA, Vida J, Parisi JE, Jentoft ME. Hypothalamic hamartoma with neurofibrillary tangles. Neuropathology 2016; 36:480-484. [PMID: 27090596 DOI: 10.1111/neup.12296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 01/21/2023]
Abstract
Hypothalamic hamartomas are rare tumors that typically present in childhood, often with gelastic seizures, precocious puberty, or as a manifestation of Pallister-Hall syndrome. Neurofibrillary tangles are cytoplasmic aggregates of hyperphosphorylated tau that are best recognized in Alzheimer disease, other tau-associated neurodegenerative diseases, or as part of aging, but occasionally may be seen in low-grade neoplasms with a ganglion cell component as gangliocytoma or ganglioglioma. Herein, we report a case of hypothalamic hamartoma with neurofibrillary tangles.
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Affiliation(s)
- Seiji Yamada
- Department of Experimental Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jawad A Shah
- Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Jonathan Vida
- Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Joseph E Parisi
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Jentoft
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
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20
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Saitsu H, Sonoda M, Higashijima T, Shirozu H, Masuda H, Tohyama J, Kato M, Nakashima M, Tsurusaki Y, Mizuguchi T, Miyatake S, Miyake N, Kameyama S, Matsumoto N. Somatic mutations in GLI3 and OFD1 involved in sonic hedgehog signaling cause hypothalamic hamartoma. Ann Clin Transl Neurol 2016; 3:356-65. [PMID: 27231705 PMCID: PMC4863748 DOI: 10.1002/acn3.300] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 01/14/2023] Open
Abstract
Objective Hypothalamic hamartoma (HH) is a congenital anomalous brain tumor. Although most HHs are found without any other systemic features, HH is observed in syndromic disorders such as Pallister–Hall syndrome (PHS) and oral‐facial‐digital syndrome (OFD). Here, we explore the possible involvement of somatic mutations in HH. Methods We analyzed paired blood and hamartoma samples from 18 individuals, including three with digital anomalies, by whole‐exome sequencing. Detected somatic mutations were validated by Sanger sequencing and deep sequencing of target amplicons. The effect of GLI3 mutations on its transcriptional properties was evaluated by luciferase assays using reporters containing eight copies of the GLI‐binding site and a mutated control sequence disrupting GLI binding. Results We found hamartoma‐specific somatic truncation mutations in GLI3 and OFD1, known regulators of sonic hedgehog (Shh) signaling, in two and three individuals, respectively. Deep sequencing of amplicons covering the mutations showed mutant allele rates of 7–54%. Somatic mutations in OFD1 at Xp22 were found only in male individuals. Potential pathogenic somatic mutations in UBR5 and ZNF263 were also identified in each individual. Germline nonsense mutations in GLI3 and OFD1 were identified in each individual with PHS and OFD type I in our series, respectively. The truncated GLI3 showed stronger repressor activity than the wild‐type protein. We did not detect somatic mutations in the remaining 9 individuals. Interpretation Our data indicate that a spectrum of human disorders can be caused by lesion‐specific somatic mutations, and suggest that impaired Shh signaling is one of the pathomechanisms of HH.
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Affiliation(s)
- Hirotomo Saitsu
- Department of Human Genetics Yokohama City University Graduate School of Medicine Yokohama 236-0004 Japan; Department of Biochemistry Hamamatsu University School of Medicine Hamamatsu 431-3192 Japan
| | - Masaki Sonoda
- Department of Functional Neurosurgery Epilepsy Center Nishi-Niigata Chuo National Hospital Niigata 950-2085 Japan
| | - Takefumi Higashijima
- Department of Functional Neurosurgery Epilepsy Center Nishi-Niigata Chuo National Hospital Niigata 950-2085 Japan
| | - Hiroshi Shirozu
- Department of Functional Neurosurgery Epilepsy Center Nishi-Niigata Chuo National Hospital Niigata 950-2085 Japan
| | - Hiroshi Masuda
- Department of Functional Neurosurgery Epilepsy Center Nishi-Niigata Chuo National Hospital Niigata 950-2085 Japan
| | - Jun Tohyama
- Department of Child Neurology Nishi-Niigata Chuo National Hospital Niigata 950-2085 Japan
| | - Mitsuhiro Kato
- Department of Pediatrics Showa University School of Medicine Tokyo 142-8666 Japan
| | - Mitsuko Nakashima
- Department of Human Genetics Yokohama City University Graduate School of Medicine Yokohama 236-0004 Japan
| | - Yoshinori Tsurusaki
- Clinical Research Institute Kanagawa Children's Medical Center Yokohama 232-8555 Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics Yokohama City University Graduate School of Medicine Yokohama 236-0004 Japan
| | - Satoko Miyatake
- Department of Human Genetics Yokohama City University Graduate School of Medicine Yokohama 236-0004 Japan
| | - Noriko Miyake
- Department of Human Genetics Yokohama City University Graduate School of Medicine Yokohama 236-0004 Japan
| | - Shigeki Kameyama
- Department of Functional Neurosurgery Epilepsy Center Nishi-Niigata Chuo National Hospital Niigata 950-2085 Japan
| | - Naomichi Matsumoto
- Department of Human Genetics Yokohama City University Graduate School of Medicine Yokohama 236-0004 Japan
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21
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Vinogradova LV, Grinenko OA. Ictal electrographic pattern of focal subcortical seizures induced by sound in rats. Brain Res 2016; 1635:161-8. [DOI: 10.1016/j.brainres.2016.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/12/2015] [Accepted: 01/18/2016] [Indexed: 02/03/2023]
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22
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Rolston JD, Chang EF. Stereotactic Laser Ablation for Hypothalamic Hamartoma. Neurosurg Clin N Am 2016; 27:59-67. [DOI: 10.1016/j.nec.2015.08.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Fink C, Borchert M, Simon CZ, Saper C. Hypothalamic dysfunction without hamartomas causing gelastic seizures in optic nerve hypoplasia. J Child Neurol 2015; 30:233-7. [PMID: 24700666 DOI: 10.1177/0883073814527156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes gelastic seizures in patients with optic nerve hypoplasia and hypothalamic dysfunction without hypothalamic hamartoma. All participants (n = 4) from the optic nerve hypoplasia registry study at Children's Hospital Los Angeles presenting with gelastic seizures were included. The clinical and pathology characteristics include hypothalamic dysgenesis and dysfunction, but no hamartomas. Optic nerve hypoplasia is the only reported condition with gelastic seizures without hypothalamic hamartomas, suggesting that hypothalamic disorganization alone can cause gelastic seizures.
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Affiliation(s)
- Cassandra Fink
- The Vision Center, Division of Ophthalmology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark Borchert
- The Vision Center, Division of Ophthalmology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Carrie Zaslow Simon
- North Shore - Long Island Jewish Health System at Hofstra University, Long Island, NY, USA
| | - Clifford Saper
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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24
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Wu J, Gao M, Shen JX, Qiu SF, Kerrigan JF. Mechanisms of intrinsic epileptogenesis in human gelastic seizures with hypothalamic hamartoma. CNS Neurosci Ther 2014; 21:104-11. [PMID: 25495642 DOI: 10.1111/cns.12348] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 12/24/2022] Open
Abstract
Human hypothalamic hamartoma (HH) is a rare developmental malformation often characterized by gelastic seizures, which are refractory to medical therapy. Ictal EEG recordings from the HH have demonstrated that the epileptic source of gelastic seizures lies within the HH lesion itself. Recent advances in surgical techniques targeting HH have led to dramatic improvements in seizure control, which further supports the hypothesis that gelastic seizures originate within the HH. However, the basic cellular and molecular mechanisms of epileptogenesis in this subcortical lesion are poorly understood. Since 2003, Barrow Neurological Institute has maintained a multidisciplinary clinical program to evaluate and treat patients with HH. This program has provided a unique opportunity to investigate the basic mechanisms of epileptogenesis using surgically resected HH tissue. The first report on the electrophysiological properties of HH neurons was published in 2005. Since then, ongoing research has provided additional insights into the mechanisms by which HH generate seizure activity. In this review, we summarize this progress and propose a cellular model that suggests that GABA-mediated excitation contributes to epileptogenesis in HH lesions.
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Affiliation(s)
- Jie Wu
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; Department of Physiology, Shantou University of Medical College, Shantou, Guangdong, China; Department of Basic Medical Sciences, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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25
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Steinmetz PN, Wait SD, Lekovic GP, Rekate HL, Kerrigan JF. Firing behavior and network activity of single neurons in human epileptic hypothalamic hamartoma. Front Neurol 2013; 4:210. [PMID: 24409165 PMCID: PMC3873534 DOI: 10.3389/fneur.2013.00210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/11/2013] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Human hypothalamic hamartomas (HH) are intrinsically epileptogenic and are associated with treatment-resistant gelastic seizures. The basic cellular mechanisms responsible for seizure onset within HH are unknown. We used intra-operative microwire recordings of single neuron activity to measure the spontaneous firing rate of neurons and the degree of functional connection between neurons within the tumor. TECHNIQUE Fourteen patients underwent transventricular endoscopic resection of HH for treatment-resistant epilepsy. Prior to surgical resection, single neuron recordings from bundled microwires (total of nine contacts) were obtained from HH tissue. Spontaneous activity was recorded for two or three 5-min epochs under steady-state general anesthesia. Off-line analysis included cluster analysis of single unit activity and probability analysis of firing relationships between pairs of neurons. RESULTS Altogether, 222 neurons were identified (mean 6 neurons per recording epoch). Cluster analysis of single neuron firing utilizing a mixture of Gaussians model identified two distinct populations on the basis of firing rate (median firing frequency 0.6 versus 15.0 spikes per second; p < 10(-5)). Cluster analysis identified three populations determined by levels of burst firing (median burst indices of 0.015, 0.18, and 0.39; p < 10(-15)). Unbiased analysis of spontaneous single unit behavior showed that 51% of all possible neuron pairs within each recording epoch had a significant level of firing synchrony (p < 10(-15)). The subgroup of neurons with higher median firing frequencies was more likely to demonstrate synchronous firing (p < 10(-7)). CONCLUSION Hypothalamic hamartoma tissue in vivo contains neurons which fire spontaneously. The activity of single neurons is diverse but distributes into at least two electrophysiological phenoytpes. Functional linkage between single neurons suggests that HH neurons exist within local networks that may contribute to ictogenesis.
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Affiliation(s)
- Peter N. Steinmetz
- Comprehensive Epilepsy Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Scott D. Wait
- Carolina Neurosurgery and Spine Associates, Levine Children’s Hospital, Carolinas Medical Center, Charlotte, NC, USA
| | - Gregory P. Lekovic
- House Ear Institute, University of Southern California School of Medicine, Los Angeles, CA, USA
| | - Harold L. Rekate
- The Chiari Institute, Hofstra Northshore LIJ College of Medicine, Great Neck, NY, USA
| | - John F. Kerrigan
- Comprehensive Epilepsy Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
- Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, USA
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26
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Wojcik SM, Tantra M, Stepniak B, Man KNM, Müller-Ribbe K, Begemann M, Ju A, Papiol S, Ronnenberg A, Gurvich A, Shin Y, Augustin I, Brose N, Ehrenreich H. Genetic markers of a Munc13 protein family member, BAIAP3, are gender specifically associated with anxiety and benzodiazepine abuse in mice and humans. Mol Med 2013; 19:135-48. [PMID: 23698091 DOI: 10.2119/molmed.2013.00033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/14/2013] [Indexed: 01/02/2023] Open
Abstract
Anxiety disorders and substance abuse, including benzodiazepine use disorder, frequently occur together. Unfortunately, treatment of anxiety disorders still includes benzodiazepines, and patients with an existing comorbid benzodiazepine use disorder or a genetic susceptibility for benzodiazepine use disorder may be at risk of adverse treatment outcomes. The identification of genetic predictors for anxiety disorders, and especially for benzodiazepine use disorder, could aid the selection of the best treatment option and improve clinical outcomes. The brain-specific angiogenesis inhibitor I-associated protein 3 (Baiap3) is a member of the mammalian uncoordinated 13 (Munc13) protein family of synaptic regulators of neurotransmitter exocytosis, with a striking expression pattern in amygdalae, hypothalamus and periaqueductal gray. Deletion of Baiap3 in mice leads to enhanced seizure propensity and increased anxiety, with the latter being more pronounced in female than in male animals. We hypothesized that genetic variation in human BAIAP3 may also be associated with anxiety. By using a phenotype-based genetic association study, we identified two human BAIAP3 single-nucleotide polymorphism risk genotypes (AA for rs2235632, TT for rs1132358) that show a significant association with anxiety in women and, surprisingly, with benzodiazepine abuse in men. Returning to mice, we found that male, but not female, Baiap3 knockout (KO) mice develop tolerance to diazepam more quickly than control animals. Analysis of cultured Baiap3 KO hypothalamus slices revealed an increase in basal network activity and an altered response to diazepam withdrawal. Thus, Baiap3/BAIAP3 is gender specifically associated with anxiety and benzodiazepine use disorder, and the analysis of Baiap3/BAIAP3-related functions may help elucidate mechanisms underlying the development of both disorders.
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Affiliation(s)
- Sonja M Wojcik
- Max Planck Institute of Experimental Medicine, Department of Molecular Neurobiology, Göttingen, Germany.
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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.
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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
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Castaño De La Mota C, Martín Del Valle F, Pérez Villena A, Calleja Gero M, Losada Del Pozo R, Ruiz-Falcó Rojas M. Hypothalamic hamartoma in paediatric patients: Clinical characteristics, outcomes and review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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29
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Castaño De La Mota C, Martín Del Valle F, Pérez Villena A, Calleja Gero ML, Losada Del Pozo R, Ruiz-Falcó Rojas ML. Hamartoma hipotalámico en la edad pediátrica: características clínicas, evolución y revisión de la literatura. Neurologia 2012; 27:268-76. [PMID: 22341983 DOI: 10.1016/j.nrl.2011.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 11/06/2011] [Accepted: 12/20/2011] [Indexed: 12/01/2022] Open
Affiliation(s)
- C Castaño De La Mota
- Unidad de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España.
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Striano S, Santulli L, Ianniciello M, Ferretti M, Romanelli P, Striano P. The gelastic seizures-hypothalamic hamartoma syndrome: facts, hypotheses, and perspectives. Epilepsy Behav 2012; 24:7-13. [PMID: 22503469 DOI: 10.1016/j.yebeh.2012.02.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/12/2012] [Accepted: 02/14/2012] [Indexed: 11/15/2022]
Abstract
Hypothalamic hamartoma (HH) can be associated with a wide spectrum of epileptic conditions, ranging from a mild form with seizures characterized by urge to laugh and no cognitive involvement up to a catastrophic encephalopathy with early onset gelastic seizures (GS), precocious puberty, and mental retardation. Moreover, a refractory, either focal or generalized, epilepsy develops during the clinical course in nearly all the cases. Neurophysiologic and neuroimaging studies have demonstrated that HH itself generates GS and starts a process of secondary epileptogenesis responsible for refractory focal or generalized epilepsy. The intrinsic epileptogenicity of HH may be explained by the neurophysiological properties of small GABAergic, spontaneously firing HH neurons. Surgical ablation of HH can reverse epilepsy and encephalopathy. Gamma-knife radiosurgery and image-guided robotic radiosurgery seem to be useful and safe approaches for treatment, in particular of small HH. Here, we review this topic, based on literature reports and our personal observations. In addition, we discuss pathogenetic hypotheses and suggest new approaches to this intriguing issue.
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Affiliation(s)
- Salvatore Striano
- Epilepsy Center, Department of Neurological Sciences, Federico II University, Napoli, Italy.
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31
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Chapman KE, Kim DY, Rho JM, Ng YT, Kerrigan JF. Ketogenic diet in the treatment of seizures associated with hypothalamic hamartomas. Epilepsy Res 2011; 94:218-21. [PMID: 21377333 DOI: 10.1016/j.eplepsyres.2011.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/23/2011] [Accepted: 02/06/2011] [Indexed: 10/18/2022]
Abstract
Seizures associated with hypothalamic hamartoma (HH) are notoriously intractable to medical therapy, and while surgical resection affords most affected patients with complete or near seizure-freedom, there remains a need to identify alternative treatments. In this retrospective study, we identified six patients from a large cohort of 220 patients with HH who were treated with the ketogenic diet (KD). Four patients had a 50-90% reduction in multiple seizure types (including gelastic, partial-onset and atonic seizures), and two individuals failed to respond. In order to study possible mechanisms, we then performed microelectrode recordings of small neurons in surgically resected HH tissue slices. Exposure to ketone bodies decreased spontaneous firing in 5 of 7 small HH neurons. These preliminary results suggest that seizures associated with HH may respond favorably to the KD, and that ketone bodies might directly modulate the intrinsic epileptogenicity of HH tissue.
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Affiliation(s)
- Kevin E Chapman
- Barrow Neurological Institute and St. Joseph's Hospital & Medical Center, Phoenix, AZ 85013, USA
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32
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Wait SD, Abla AA, Killory BD, Nakaji P, Rekate HL. Surgical approaches to hypothalamic hamartomas. Neurosurg Focus 2011; 30:E2. [PMID: 21374830 DOI: 10.3171/2010.11.focus10250] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Object
Hypothalamic hamartomas (HHs) are devastating lesions causing refractory epilepsy, rage attacks, social ineptitude, and precocious puberty. Microsurgical and/or endoscopic resection offers an excellent risk/benefit profile for cure or improvement of epilepsy.
Methods
The authors reviewed a prospective database maintained during the first 7 years of the Barrow Hypothalamic Hamartoma program. They describe and illustrate their surgical methods, and they review data from several previous publications regarding surgical outcome.
Results
To date, the authors have performed surgery in 165 patients for symptomatic HHs. Patients underwent an endoscopic, transcallosal, or skull base approach, or multiple approaches. Twenty-six patients (15.8%) required more than 1 treatment for their HH.
Conclusions
Microsurgical and endoscopic resection of symptomatic HHs are technically demanding but can be performed safely with excellent results and an acceptable risk profile. Meticulous attention to the subtleties of surgical management helps optimize outcomes.
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Abstract
The prognosis for patients with hypothalamic hamartoma has improved dramatically over the last 20 years, for 3 main reasons. First, because of improved understanding of the anatomy and pathophysiology of these varied lesions. Second, due to advances in brain imaging and refinements in microsurgery, including the anterior transcallosal interforniceal approach, endoscopic, and skull-base approaches. And third, because of increasing experience with stereotactic radiosurgery, interstitial radiotherapy, and radiofrequency lesioning. Patients with hypothalamic hamartoma should be managed in comprehensive epilepsy centers where the treatments are individualized and concentrated in the hands of surgeons who can perform the full range of surgery, including approaches to the third ventricle. Total seizure-freedom rates of 52% to 66% have been achieved with surgery.
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Simeone KA, Sabesan S, Kim DY, Kerrigan JF, Rho JM, Simeone TA. L-Type calcium channel blockade reduces network activity in human epileptic hypothalamic hamartoma tissue. Epilepsia 2011; 52:531-40. [PMID: 21269296 PMCID: PMC3071288 DOI: 10.1111/j.1528-1167.2010.02942.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose Human hypothalamic hamartomas (HHs) are associated with gelastic seizures, intrinsically epileptogenic, and notoriously refractory to medical therapy. We previously reported that the L-type calcium channel antagonist nifedipine blocks spontaneous firing and γ-aminobutyric acid (GABA)A–induced depolarization of single cells in HH tissue slices. In this study, we examined whether blocking L-type calcium channels attenuates emergent activity of HH neuronal networks. Methods A high-density multielectrode array was used to record extracellular signals from surgically resected HH tissue slices. High-frequency oscillations (HFOs, ripples and fast ripples), field potentials, and multiunit activity (MUA) were studied (1) under normal and provoked [4-aminopyridine (4-AP)] conditions; and (2) following nifedipine treatment. Key Findings Spontaneous activity occurred during normal artificial cerebrospinal fluid (aCSF) conditions. Nifedipine reduced the total number and duration of HFOs, abolished the association of HFOs with field potentials, and increased the inter-HFO burst intervals. Notably, the number of active regions was decreased by 45 ± 9% (mean ± SEM) after nifedipine treatment. When considering electrodes that detected activity, nifedipine increased MUA in 58% of electrodes and reduced the number of field potentials in 67% of electrodes. Provocation with 4-AP increased the number of events and, as the number of electrodes that detected activity increased 248 ± 62%, promoted tissue-wide propagation of activity. During provocation with 4-AP, nifedipine effectively reduced HFOs, the association of HFOs with field potentials, field potentials, MUA, and the number of active regions, and limited propagation. Significance This is the first study to report (1) the presence of HFOs in human subcortical epileptic brain tissue in vitro; (2) the modulation of “pathologic” high-frequency oscillations (i.e., fast ripples) in human epileptic tissue by L-type calcium channel blockers; and (3) the modulation of network physiology and synchrony of emergent activity in human epileptic tissue following blockade of L-type calcium channels. Attenuation of activity in HH tissue during normal and provoked conditions supports a potential therapeutic usefulness of L-type calcium channel blockers in epileptic patients with HH.
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Affiliation(s)
- Kristina A Simeone
- Divisions of Neurology and Pediatric Neurology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Roberts CM, Thompson EM, Selden NR. Transendoscopic intraoperative recording of gelastic seizures from a hypothalamic hamartoma. Pediatr Neurosurg 2011; 47:147-51. [PMID: 21921578 DOI: 10.1159/000330547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 07/03/2011] [Indexed: 12/27/2022]
Abstract
OBJECT The differential diagnosis of hypothalamic masses in children includes hamartomas, which are associated with gelastic seizures and endocrine dysfunction. The purpose of this study was to utilize transendoscopic electroencephalography (EEG) recording at the time of tissue biopsy to further assist in diagnosis, determination of prognosis, and treatment planning. METHODS We present the case of an infant with gelastic seizures and a large hypothalamic mass lesion. Despite a clinical and radiographic presentation typical of hypothalamic hamartoma (HH), slight growth on serial imaging raised concern for a diagnosis of intrinsic neoplasm. Biopsy of the lesion was recommended. RESULTS Transventricular, endoscopic biopsy, was undertaken, with concurrent intraoperative, transendoscopic EEG recording using a standard epilepsy depth recording macroelectrode. Numerous electrographic seizures were recorded. Histopathology revealed a HH. CONCLUSION This is the first report of intraoperative macroelectrode recording of electrographic seizures transendoscopically from a HH. This technique may prove useful for diagnosis, prognosis and treatment planning, as well as to guide transendoscopic therapeutic interventions for HH.
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Affiliation(s)
- Colin M Roberts
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
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Positron emission tomography with glucose hypermetabolism of a hypothalamic hamartoma in infantile spasms associated with Pallister-Hall syndrome. Brain Dev 2010; 32:677-80. [PMID: 19793630 DOI: 10.1016/j.braindev.2009.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 08/29/2009] [Accepted: 09/04/2009] [Indexed: 11/23/2022]
Abstract
Although hypothalamic hamartomas (HHs) have been shown to be intrinsically epileptogenic and to participate in the generation of gelastic seizures, no evidence has been reported regarding its contribution to the pathogenesis of infantile spasms. We describe a male infant with Pallister-Hall syndrome who had a large HH presenting with infantile spasms without hypsarrhythmia. [(18)F]fluoro-deoxyglucose positron emission tomography scan performed during the period of epileptic spasms demonstrated glucose hypermetabolism of the HH, which resolved after cessation of the spasms with adrenocorticotropin hormone treatment. No concurrent increased metabolic activity in the lenticular nuclei or brainstem was observed in the ictal or interictal states. The present case suggests that HHs may be involved in the pathogenesis of infantile spasms, possibly with propagation of epileptic discharges from the hamartoma to the descending spinal pathway.
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Lekovic GP, Kerrigan JF, Wait S, Rekate HL, Steinmetz PN. IN SITU SINGLE-UNIT RECORDING OF HYPOTHALAMIC HAMARTOMAS UNDER ENDOSCOPIC DIRECT VISUALIZATION. Neurosurgery 2009; 65:E1195-6; discussion E1196. [DOI: 10.1227/01.neu.0000359531.45021.52] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Hypothalamic hamartomas (HHs) are associated with refractory epilepsy and are amenable to surgical treatment. The gelastic seizures associated with HHs originate within the HH lesion, but the responsible cellular mechanisms are unknown. Microelectrode patch-clamp recordings from HH neurons in resected slice preparations show that small HH neurons spontaneously fire with intrinsic pacemaker-like activity. We questioned whether spontaneous firing of HH neurons was present in situ, and we hypothesized that single-unit field recordings from HH tissue could be obtained with instrumentation passed through the endoscope before surgical resection.
TECHNIQUE
After informed consent was obtained, patients undergoing transventricular, endoscopic resection of an HH for intractable epilepsy were eligible for study. After placement of the endoscope, a bundled microwire (total of 9 contacts) was placed into the HH under direct visualization. Spontaneous activity was recorded for two or three 5-minute epochs, under steady-state general anesthesia. The wire was advanced 0.5 to 1 mm within the lesion between recording epochs.
RESULTS
A total of thirteen 5-minute recordings were obtained from 5 patients. Noise levels were comparable to extraoperative microwire recordings for temporal lobe epilepsy. Single-neuron spike activity was isolated from a total of 5 channels obtained during recording of 3 sessions in 3 patients.
CONCLUSION
We have shown that single-unit recordings from HH lesions can be successfully obtained in situ under direct endoscopic visualization. We believe that this is the first report using the working channel of a neuroendoscope to make physiological recordings of deep structures in humans.
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Affiliation(s)
- Gregory P. Lekovic
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - John F. Kerrigan
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Scott Wait
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Harold L. Rekate
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter N. Steinmetz
- Divisions of Neurological Surgery and Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Striano S, Striano P, Coppola A, Romanelli P. The syndrome gelastic seizures-hypothalamic hamartoma: Severe, potentially reversible encephalopathy. Epilepsia 2009; 50 Suppl 5:62-5. [DOI: 10.1111/j.1528-1167.2009.02125.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Téllez-Zenteno JF, Serrano-Almeida C, Moien-Afshari F. Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment. Neuropsychiatr Dis Treat 2008; 4:1021-31. [PMID: 19337448 PMCID: PMC2646637 DOI: 10.2147/ndt.s2173] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Gelastic seizures are epileptic events characterized by bouts of laughter. Laughter-like vocalization is usually combined with facial contraction in the form of a smile. Autonomic features such as flushing, tachycardia, and altered respiration are widely recognized. Conscious state may not be impaired, although this is often difficult to asses particularly in young children. Gelastic seizures have been associated classically to hypothalamic hamartomas, although different extrahypothalamic localizations have been described. Hypothalamic hamartomas are rare congenital lesions presenting with the classic triad of gelastic epilepsy, precocious puberty and developmental delay. The clinical course of patients with gelastic seizures associated with hypothalamic hamartomas is progressive, commencing with gelastic seizures in infancy, deteriorating into more complex seizure disorder resulting in intractable epilepsy. Electrophysiological, radiological, and pathophysiological studies have confirmed the intrinsic epileptogenicity of the hypothalamic hamartoma. Currently the most effective surgical approach is the trancallosal anterior interforniceal approach, however newer approaches including the endoscopic and other treatment such as radiosurgery and gamma knife have been used with success. This review focuses on the syndrome of gelastic seizures associated with hypothalamic hamartomas, but it also reviews other concepts such as status gelasticus and some aspects of gelastic seizures in other locations.
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Affiliation(s)
- José F Téllez-Zenteno
- Division of Neurology, University of Saskatchewan, Department of Medicine, Royal University Hospital 103, Hospital Drive. BOX 26, Room 1622, Saskatoon SK S7N OW8, Canada.
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41
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Kim DY, Fenoglio KA, Simeone TA, Coons SW, Wu J, Chang Y, Kerrigan JF, Rho JM. GABAA receptor-mediated activation of L-type calcium channels induces neuronal excitation in surgically resected human hypothalamic hamartomas. Epilepsia 2008; 49:861-71. [PMID: 18076645 DOI: 10.1111/j.1528-1167.2007.01455.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The human hypothalamic hamartoma (HH) is a rare, intrinsically epileptogenic lesion associated with gelastic seizures, but the underlying mechanisms remain unclear. Here, we examined the role of GABAA receptors in surgically resected HH tissue. METHODS HH tissue slices (350 microm) were studied using cellular electrophysiological, calcium imaging, and immunocytochemical techniques. RESULTS Two neuronal cell types were seen: small (10-16 microm) spontaneously firing GABAergic neurons and large (20-28 microm) quiescent neurons. In gramicidin-perforated patch recordings, muscimol (30 microM) induced membrane depolarization in 70% of large (but not small) neurons and a concomitant rise in intracellular calcium. These responses were blocked by bicuculline methiodide (50 microM). Depolarizing neurons also exhibited more positive reversal potentials (Emuscimol) and significantly higher intracellular chloride concentrations compared to those that hyperpolarized. The cation chloride co-transporters NKCC1 and KCC2 were coexpressed in the majority of large neurons, but fluorometric measurements revealed that 84% of large HH neurons expressed solely or relatively more NKCC1. Bumetanide (20 microM), a NKCC1 antagonist, partially suppressed muscimol-induced excitation in large neurons. Concordant with robust expression of CaV1.2 and CaV1.3 subunits in HH neurons, the L-type calcium channel blocker nifedipine (100 microM) prevented muscimol-induced neuronal excitation. CONCLUSIONS GABAA receptor-mediated excitation, due in part to differential expression of NKCC1 and KCC2 and subsequent activation of L-type calcium channels, may contribute to seizure genesis in HH tissue. Given the ready availability of L-type calcium channel blockers, our results have clinical ramifications for the treatment of seizures associated with HH lesions.
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MESH Headings
- Action Potentials/drug effects
- Action Potentials/physiology
- Adolescent
- Adult
- Calcium Channels, L-Type/drug effects
- Calcium Channels, L-Type/metabolism
- Calcium Channels, L-Type/physiology
- Child, Preschool
- Chloride Channels/metabolism
- Epilepsies, Partial/metabolism
- Epilepsies, Partial/physiopathology
- Female
- Hamartoma/metabolism
- Hamartoma/physiopathology
- Hamartoma/surgery
- Humans
- Hypothalamic Diseases/metabolism
- Hypothalamic Diseases/physiopathology
- Hypothalamic Diseases/surgery
- Immunohistochemistry
- Infant
- Male
- Membrane Potentials/drug effects
- Membrane Potentials/physiology
- Models, Neurological
- Muscimol/pharmacology
- Neurons/drug effects
- Neurons/metabolism
- Neurons/physiology
- Nifedipine/pharmacology
- Patch-Clamp Techniques
- Receptors, GABA-A/drug effects
- Receptors, GABA-A/metabolism
- Receptors, GABA-A/physiology
- Sodium-Potassium-Chloride Symporters/metabolism
- Solute Carrier Family 12, Member 2
- Symporters/drug effects
- Symporters/metabolism
- K Cl- Cotransporters
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Affiliation(s)
- Do Young Kim
- Division of Pediatric Neurology, Barrow Neurological Institute, St. Joseph's Hospital & Medical Center, Phoenix, AZ 85013, USA
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Craig DW, Itty A, Panganiban C, Szelinger S, Kruer MC, Sekar A, Reiman D, Narayanan V, Stephan DA, Kerrigan JF. Identification of somatic chromosomal abnormalities in hypothalamic hamartoma tissue at the GLI3 locus. Am J Hum Genet 2008; 82:366-74. [PMID: 18252217 DOI: 10.1016/j.ajhg.2007.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/04/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022] Open
Abstract
Hypothalamic hamartomas (HH) are rare, benign congenital tumors associated with intractable epilepsy. Most cases are sporadic and nonsyndromic. Approximately 5% of HH cases are associated with Pallister-Hall syndrome (PHS), which is caused by haploinsufficiency of GLI3. We have investigated the possibility that HH pathogenesis in sporadic cases is due to a somatic (tumor-only) mutation in GLI3. We isolated genomic DNA from peripheral blood and surgically resected HH tissue in 55 patients with sporadic HH and intractable epilepsy. A genome-wide screen for loss of heterozygosity (LOH) and chromosomal abnormalities was performed with parallel analysis of blood and HH tissue with Affymetrix 10K SNP microarrays. Additionally, resequencing and fine mapping with SNP genotyping were completed for the GLI3 gene with comparisons between peripheral blood and HH tissue pairs. By analyzing chromosomal copy-number data for paired samples on the Affymetrix 10K array, we identified a somatic chromosomal abnormality on chromosome 7p in one HH tissue sample. Resequencing of GLI3 did not identify causative germline mutations but did identify LOH within the GLI3 gene in the HH tissue samples of three patients. Further genotyping of 28 SNPs within and surrounding GLI3 identified five additional patients exhibiting LOH. Together, these data provide evidence that the development of chromosomal abnormalities within GLI3 is associated with the pathogenesis of HH lesions in sporadic, nonsyndromic patients with HH and intractable epilepsy. Chromosomal abnormalities including the GLI3 locus were seen in 8 of 55 (15%) of the resected HH tissue samples. These somatic mutations appear to be highly variable.
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