Cingulate epileptogenesis in hypothalamic hamartoma

• Published in: Epilepsia (Copenhagen) Vol. 52; no. 5; pp. e35 - e39
• Main Authors: Valentin, Antonio, Lazaro, Marian, Mullatti, Nandini, Cervantes, Sebastian, Malik, Irfan, Selway, Richard P., Alarcón, Gonzalo
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2011; Wiley Subscription Services, Inc
• Subjects: Adult; Age; Brain Mapping; Children; Cortex; Cortex (cingulate); Data processing; Deep Brain Stimulation - methods; EEG; Electrical stimuli; Electrodes, Implanted; Electroencephalography; Epilepsy; Epilepsy, Frontal Lobe - etiology; Epilepsy, Frontal Lobe - physiopathology; Epilepsy, Frontal Lobe - surgery; Epileptogenesis; Gelastic seizures; Gyrus Cinguli - physiopathology; Gyrus Cinguli - surgery; Hamartoma - complications; Hamartoma - physiopathology; Hamartoma - surgery; Humans; Hypothalamic Diseases - complications; Hypothalamic Diseases - physiopathology; Hypothalamic Diseases - surgery; Hypothalamic hamartoma; Hypothalamus; Laughter - physiology; Magnetic Resonance Imaging; Male; Medical research; Neoplasia; Seizures; Single pulse electrical stimulation; Substance P; Treatment Outcome
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.1528-1167.2011.03060.x

Summary Hypothalamic hamartoma (HH) is a relatively rare cause of epilepsy, mainly affecting children. Nearly all patients develop gelastic seizures, often followed by other focal seizure types. Our case illustrates the mechanisms of epileptogenesis in HH. The patient developed gelastic attacks as a baby, and secondarily generalized seizures and drop attacks at 9 years of age. Magnetic resonance imaging (MRI) confirmed the presence of a HH. Presurgical assessment with intracranial electroencephalography (EEG) monitoring recorded gelastic seizures with generalized epileptiform activity. Functional stimulation of the hamartoma provoked gelastic attacks. Single pulse electrical stimulation (SPES) was used to identify epileptogenic cortex. SPES of the left cingular cortex provoked generalized responses similar to the spontaneous generalized discharges. Our results suggest that long‐standing history of epilepsy in patients with HH may be related to additional sources of epileptogenic activity. Electrical stimulation performed in this patient provided additional data to favor the hypothesis of secondarily epileptogenesis in the cingulate gyrus independently from the primary origin in the HH.