Neuropediatrics 2006; 37 - FV23
DOI: 10.1055/s-2006-974001

Impact of stereotactic interstitial radiosurgery on cognition in ten juvenile epilepsy patients with hypothalamic hamartoma

K Wagner 1, L Frings 1, A Quiske 2, S Bonakdar 1, F von Deimling 1, JP Ernst 3, T Bast 4, R Keimer 5, I Tuxhorn 6, CE Elger 7, A Ebner 6, C Ostertag 8, A Schulze-Bonhage 1
  • 1Universitätsklinikum Freiburg, Epilepsiezentrum, Freiburg, Germany
  • 2Kliniken der Stadt Köln, Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Köln, Germany
  • 3Epilepsiezentrum Kork, Epilepsieklinik für Kinder und Jugendliche, Kehl-Kork, Germany
  • 4Universitätsklinikum Heidelberg, Kinderneurologie, Heidelberg, Germany
  • 5Olgahospital Stuttgart, Klinik für Kinderheilkunde und Jugendmedizin, Stuttgart, Germany
  • 6Evangelisches Krankenhaus Bielefeld, Epilepsiezentrum Bethel, Bielefeld, Germany
  • 7Universitätsklinikum Bonn, Klinik für Epileptologie, Bonn, Germany
  • 8Universitätsklinikum Freiburg, Abteilung für Stereotaktische Neurochirurgie, Freiburg, Germany

Cognitive impairment as well as behavioral disturbances are associated with the epileptic syndrome of hypothalamic hamartomas. We assessed cognitive functions – including attention, verbal and visual short-term and working memory, verbal and figural declarative memory, phonematic fluency, planning, and visuoconstruction – before and after interstitial radiotherapy in ten juvenile patients with a mean age of 15.5 years and gelastic seizures due to hypothalamic hamartomas. Neuropsychological assessment was carried out before temporary implantation of a 125I-seed and at least three months after seed excision.

After a mean of 8 months, the patients showed a significant improvement in selective attention and a decline in visuoconstructive abilities. The remaining cognitive domains revealed no significant changes. The impairment in postoperative visuoconstructive functions was accompanied by a higher number of secondarily generalized seizures after seed explantation. Thus, the stereotactical implantation of 125I-seeds in this patient group with gelastic seizures due to hypothalamic hamartoma provides a well tolerated minimal invasive method in the treatment of this severe epileptic syndrome.