INTERSTITIAL RADIOTHERAPY IN THE TREATMENT OF EPILEPSY DUE TO HYPOTHALAMIC HAMARTOMA
Abstract number :
3.302
Submission category :
Year :
2002
Submission ID :
3489
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Andreas Schulze-Bonhage, Vivien Homberg, Reinhard Keimer, Peter Warnke, Christoph Ostertag. Epilepsy Centre, University of Freiburg, Freiburg, Germany; Department of Neuropediatrics, Olgahospital, Stuttgart, Germany; Department of Stereotactic Neurosurger
RATIONALE: Symptomatic focal epilepsies due to hypothalamic hamartomas have remained remarkable refractory to any medical treatment so far. Open surgery, on the other hand, has a high risk of side effects. As the epilepsy often compromises also the patient[prime]s behavior negatively, there is a need for other treatment options. Recently, radiotherapy of hypothalamic harmartomas using gamma-knife has been reported to be promising. We report the effects of interstitial radiotherapy on seizure outcome in a series of 6 patients with gelastic epilepsy due to hypothalamic hamartomas treated in Freiburg.
METHODS: 6 patients (5 male, 1 female, 9-32 years of age) with pharmacorefractory epilepsy suffering from gelastic, complex partial and secondarily generalized seizures due to a sessile hypothalamic hamartoma were treated using interstitial radiotherapy. The hamartoma was identified using T1-wheighted 3D MRI data sets. In addition to non-invasive presurgical monitoring, 5/6 patients had invasive recordings from the hamartoma using depth electrodes. Treatment was performed by stereotactic insertion of 125J-seeds into the hamartoma for a mean period of 26 days.
RESULTS: 2/6 patients have remained seizure free a follow-up period of 1 year so far. 1 patient had an initial reduction in seizure frequency but remitted; he has had a second seed implantation and has remained seizure-free for 6 months now. One more patient had a seizure reduction by more than 50 %. In one patient, the seed could not be placed in the hamartoma, and one patient did not profit from an implantation so far. Serious side effects did not occur, in particular there were neither emerging endocrine disorders nor visual field defects.
CONCLUSIONS: As far as can be presently judged by these data, steretotactic interstitial radiotherapy seems to offer an effective alternative in the therapy of pharmacorefractory epilepsy due to hypothalamic hamartoma. Due to the lack of significant side effects, it may be preferable to open surgery at least in the sessile type of hamartoma.