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NEUROLOGY 2008;71:277-282
© 2008 American Academy of Neurology

Outcome and predictors of interstitial radiosurgery in the treatment of gelastic epilepsy

A. Schulze-Bonhage, MD, PhD, M. Trippel, MD, K. Wagner, PhD, T. Bast, MD, F. V. Deimling, MD, A. Ebner, MD, C. Elger, MD, PhD, T. Mayer, MD, R. Keimer, MD, B. J. Steinhoff, MD, PhD, J. Spreer, MD, PhD, S. Fauser, MD and C. Ostertag, MD, PhD

From the Epilepsy Center (A.S.-B., K.W., F.V.D., S.F.), Department Stereotactic Neurosurgery (M.T., C.O.), and Department Neuroradiology (J.S.), University Hospital Freiburg; Department Pediatric Neurology (T.B.), University Hospital Heidelberg; Epilepsy Center Bethel (A.E.); Clinic of Epileptology (C.E.), University Hospital Bonn; Epilepsy Center Kleinwachau (T.M.); Olgahospital Stuttgart (R.K.); and Epilepsy Center Kork (B.J.S.), Germany.

Address correspondence and reprint requests to Prof. Dr. Andreas Schulze-Bonhage, Epilepsy Center, Neurocentre, University Hospital Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany andreas.schulze-bonhage{at}uniklinik-freiburg.de

Background: Gelastic epilepsy due to hypothalamic hamartomas is usually a severe condition encompassing both epileptic seizures and an epileptic encephalopathy associated with behavioral and cognitive impairments. Here we report the effects of interstitial radiosurgery in the treatment of this generally pharmacoresistant epilepsy syndrome.

Methods: Twenty-four consecutive patients (3–46 years of age, 7 women, mean age 21.9 years, mean duration of epilepsy 17.6 years) with gelastic epilepsy due to MR-ascertained hypothalamic hamartoma and a minimum follow-up period of 1 year were included in this evaluation. Treatment was performed by interstitial radiosurgery using stereotactically implanted 125I seeds. Effects of treatment on seizure frequency and possible side effects were assessed prospectively. Factors influencing outcome and side effects were analyzed statistically.

Results: After a mean 24-month follow-up period following the last radiosurgical treatment, 11/24 patients were seizure free or had seizure reduction of at least 90% (Engel class I and II), in some cases only after repeated treatment. The duration of epilepsy prior to radiosurgery negatively influenced outcome. Treatment was well tolerated in most patients. Headache, fatigue, and lethargy were transient side effects associated with the development of brain edema extending from the implantation site in five patients. Four patients had a weight gain of more than 5 kg which was severe in two patients. The majority of those patients whose cognitive functions initially deteriorated showed subsequent recovery of cognitive functions, but episodic memory in two patients showed persistent decline at 1 year follow-up. Longer disease duration increased the risk for cognitive side effects, and larger hamartoma size and eccentric seed positioning increased the risk for radiogenic brain edema. Neither perioperative mortality nor neurologic impairments, visual field defects, or endocrinologic disturbances were encountered following treatment.

Conclusion: Interstitial radiosurgery was efficacious in significantly improving gelastic epilepsy in about half of the patients treated in this series. Weight gain may occur as a side effect, whereas other severe side effects reported following microsurgical removal of the hamartoma were absent. The study results strongly suggest early causal treatment, as chances for seizure control are higher and the risk for cognitive side effects is lower in patients with shorter disease duration.

Abbreviations: AC-PC = anterior–posterior; HH = hypothalamic hamartomas.

Disclosure: The authors report no disclosures.

Received July 24, 2007. Accepted in final form April 4, 2008.






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