Publication

Increased Gray Matter Density in the Right Mesencephalic Tegmentum Is Associated With Better Engel Classes I and II After Radiosurgery for Hypothalamic Hamartomas

Résumé

BACKGROUND:Hypothalamic hamartomas (HHs) are disabling congenital lesions, responsible for gelastic seizures frequently associated with catastrophic epilepsies, epileptogenic encephalopathy, and cognitive and psychiatric severe comorbidities. Stereotactic radiosurgery (SRS) is a well-established minimally invasive therapeutic approach.OBJECTIVE:To assess whether pretherapeutic gray matter density (GMD) correlates with seizure outcome.METHODS:We used voxel-based morphometry at whole-brain level, as depicted on pretherapeutic standard structural magnetic resonance neuroimaging. We examined 24 patients (10 male patients, 14 female patients; mean age, 12.7 yr; median, 9; range, 5.9-50) treated in Marseille University Hospital, France, between May 2001 and August 2018.RESULTS:Most relevant anatomic area predicting postoperative Engel classes I and II vs III and IV after SRS for HHs was mesencephalic tegmentum. Higher pretherapeutic GMD in this area was associated with better outcomes for seizure cessation. The only other statistically significant clusters were right cerebellar lobule VIIIb and VIIIa. Lower pretherapeutic GMD in both clusters correlated with better Engel class outcomes. GMD decreased with age in the left mediodorsal thalamus.CONCLUSION:Seizure cessation after SRS for HHs was associated with higher GMD in mesencephalic tegmental area, acknowledged to be involved in the neural control of explosive vocal behavior in animals. This area is connected by the mamillotegmental bundle to the lateral tuberal nucleus area of the hypothalamus, where HHs are known to rise. In the future, the detection of more gray matter in this "laugh" tegmental area based on pretherapeutic routine structural neuroimaging might help in patient selection for minimally invasive radiosurgery for HH.

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Concepts associés (40)
Seizure types
In the field of neurology, seizure types are categories of seizures defined by seizure behavior, symptoms, and diagnostic tests. The International League Against Epilepsy (ILAE) 2017 classification of seizures is the internationally recognized standard for identifying seizure types. The ILAE 2017 classification of seizures is a revision of the prior ILAE 1981 classification of seizures. Distinguishing between seizure types is important since different types of seizures may have different causes, outcomes, and treatments.
Épilepsie
L', aussi appelée mal comitial, est une affection neurologique qui touche plus de 50 millions de personnes à travers le monde. Elle est définie comme une famille de maladies dont le point commun est une prédisposition cérébrale à engendrer des « crises » épileptiques dites « non provoquées », c'est-à-dire spontanées, non expliquées par un facteur causal immédiat.
Crise non-épileptique psychogène
Les crises non-épileptiques psychogènes (CNEP ou crises non épileptiques) sont des événements ressemblant à des crises d'épilepsie, mais sans les décharges électriques caractéristiques associées à l'épilepsie. Les CNEP entrent dans la catégorie des troubles connus sous le nom de troubles neurologiques fonctionnels, également appelés troubles de conversion. Un terme plus récent pour décrire ces événements est les crises dissociatives non-épileptiques. Elles sont généralement traitées par des psychologues ou des psychiatres.
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