Seizure outcome and prognostic factors for surgical management of hypothalamic hamartomas in children
| Autor: | Christine Bulteau, Nathalie Dorison, Georg Dorfmüller, Mathilde Chipaux, Pauline Chamard, Mikael Levy, Martin Tisdall, Sarah Ferrand-Sorbets, Martine Fohlen, Kevin Zuber, Delphine Taussig, Olivier Bekaert, Olivier Delalande |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Time Factors Hamartoma Single Center Stereotaxic Techniques 03 medical and health sciences Epilepsy 0302 clinical medicine Hypothalamic hamartoma Median follow-up Gelastic seizure Outcome Assessment Health Care medicine Humans Child Retrospective Studies business.industry Seizure types Infant Seizure outcome General Medicine Prognosis medicine.disease Neurology Child Preschool Neuroendoscopy Female Neurology (clinical) medicine.symptom business Hypothalamic Diseases 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Seizure. 75:28-33 |
| ISSN: | 1059-1311 |
| DOI: | 10.1016/j.seizure.2019.11.013 |
| Popis: | Purpose Hypothalamic hamartomas (HH) are rare benign lesions frequently associated with gelastic seizures early in life. Epilepsy can progress to multiple seizure types with cognitive impairment and behavioural disturbance, leading in some cases to epileptic encephalopathy. Methods We reviewed a retrospective series of 112 children treated in a single center, between 1998 and 2017. Results According to Delalande’s HH classification, type1 was found in 2 patients, type 2 in 67, type 3 in 31, and type 4 in 12 patients. Stereotactic endoscopic disconnection was performed in 92 % of the procedures. Median age at diagnosis was 40 months and 7.6 years at surgery. Median time between diagnosis and surgery was 31 months and median follow up 4.1 years. For all HH types, 77.6 % of the patients had a favourable outcome (Engel I + II outcome score) with 57.1 % seizure-free (Engel I). The best outcome was obtained in patients with type 2 HH, (68.7 % Engel I and 85.1 % Engel I + II). The overall complication rate was 8.3 %, which is in line with previous series. Patients with isolated gelastic seizures had a better outcome (Engel I + II in 90 %), as compared to those with other seizure types (p = 0.07). A short delay between hamartoma diagnosis and surgery was a statistically significant factor for a good outcome (p = 0.03). Conclusion Patients with HH and drug-resistant epilepsy should be early identified in order to propose surgical treatment without delay. Endoscopic disconnection is a safe and efficacious surgical option with good seizure outcome and immediate treatment results. |
| Databáze: | OpenAIRE |
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