Photo Credit: gorodenkoff

The following is a summary of “Outcome of Surgery for Hypothalamic Hamartoma-Related Epilepsy: A Systematic Review and Individual Participant Data Meta-Analysis,” published in the December 2024 issue of Neurology by Niazi et al.  

Hypothalamic hamartomas (HHs) can lead to epilepsy, and limited data is comparing surgical treatment outcomes for individuals with HH-related epilepsy.  

Researchers conducted a retrospective study to evaluate surgical outcomes for individuals with HH-related epilepsy.  

They conducted a systematic review and individual participant data (IPD) meta-analysis of studies on surgical treatments for HH-related epilepsy. A random-effects model calculated pooled proportions of seizure freedom (Engel I) at follow-up, and mixed-effects logistic regression identified predictors of seizure freedom and significant complications.  

The results showed that 50.0% (95% CI 42.7%–57.4%) of individuals were seizure-free after the initial surgery, increasing to 64.5% (95% CI 57.2%–71.5%) after multiple treatments. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and radiofrequency thermocoagulation (RFTC) had the highest efficacy, with seizure freedom rates of 74.5% (95% CI 66.8%–81.7%) and 78.5% (95% CI 71.6%–84.8%), respectively. Factors such as multiple seizure types (OR 0.296, 95% CI 0.140–0.624, P=0.001) and previous surgery (OR 0.418, 95% CI 0.198–0.884, P=0.023) were linked to a lower likelihood of seizure freedom. Stereotactic radiosurgery (SRS) was the safest approach, with significant complication rates of 0.0% (95% CI 0.0%–1.4%). Surgical technique was an independent predictor of significant complications, with SRS (OR 0.024, 95% CI 0.002–0.292, P=0.004), RFTC (OR 0.133, 95% CI 0.026–0.692, P=0.017), and MRgLITT (OR 0.234, 95% CI 0.056–0.968, P=0.045) showing lower complication rates.  

They concluded that MRgLITT and RFTC offered better efficacy and safety compared to open microsurgery, and SRS remained a viable option for some instances.  

Source: neurology.org/doi/10.1212/WNL.0000000000210060