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Predictors of cognitive function in patients with hypothalamic hamartoma following stereotactic radiofrequency thermocoagulation surgery
Author(s) -
Sonoda Masaki,
Masuda Hiroshi,
Shirozu Hiroshi,
Ito Yosuke,
Akazawa Kohei,
Asano Eishi,
Kameyama Shigeki
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13838
Subject(s) - radiofrequency thermocoagulation , medicine , neuropsychology , cognition , epilepsy surgery , hypothalamic hamartoma , univariate analysis , epilepsy , multivariate analysis , effects of sleep deprivation on cognitive performance , anesthesia , surgery , pediatrics , psychiatry , trigeminal neuralgia , precocious puberty , hormone
Summary Objective To determine the predictors of cognitive function in patients with drug‐resistant gelastic seizures ( GS ) related to hypothalamic hamartoma ( HH ) before and after stereotactic radiofrequency thermocoagulation surgery ( SRT ). Methods We studied 88 patients with HH who underwent SRT between October 1997 and December 2014. Patients received neuropsychological tests preoperatively and postoperatively. Based on the preoperative measures, patients were categorized as “high‐functioning” (full‐scale intelligence quotient [ FSIQ ] ≥70; n = 48) and “low‐functioning” group ( FSIQ <70; n = 40). Univariate and multivariate linear regression analyses determined the clinical, electroencephalography ( EEG ), and imaging factors associated with preoperative cognitive function as well as postoperative cognitive change. Results Eighty‐seven patients (98.8%) were followed postoperatively for an average of 3.3 years, and 75 (85.2%) of them achieved GS remission at the last hospital visit. Neuropsychological performance was significantly improved after surgery in both groups. Multivariate linear regression analysis showed that a smaller HH size (p = 0.002) and a smaller number of antiepileptic drugs (p < 0.001) were preoperatively associated with better neuropsychological performance. Multivariate linear regression analysis showed that better postoperative improvement in cognition was associated with a shorter duration of epilepsy (p = 0.03). Significance Cognitive impairment related to epileptic encephalopathy may improve following SRT in substantial proportions of HH patients. Reduced improvement in postoperative cognitive function in patients with longer duration of epilepsy warrants further studies to determine if earlier SRT provides a greater chance of postoperative cognitive improvement in patients with HH .