Gelastic epilepsy a case study neuroimaging and therapeutic by mikeholy

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									Gelastic epilepsy: a case study neuroimaging and therapeutic options
M.Spilioti 1, E.Dimitracoudi 1, G.Xiromerisiou 1, EZ Kapsalaki ³, H.Rekatte4, A.Karlovasitou²,S.I.Balogiannis 1



1
    First Neurological Clinic Aristotle University of Thessaloniki, Greece
2
    Laboratory of Clinical Neurolophysiology, Aristotle University of Thessaloniki, ΑHΕPΑ Hospital Greece
3
    University Hospital of Larissa, University of Thessaly Dept of diagnostic Radiology Neurology
4
    BARROW Neurological Institute, Phoenix, Arizona.




Purpose: Gelastic epilepsy (GE) is related with hypothalamic hamartomas(HHs). The seizures in HH
patients are typically refractory to treatment.
A small number of studies have shown promise for radiosurgery as an alternative less invasive
method for treating HHs.
We described a patient with intractable gelastic epilepsy related with a hypothalamic hamartoma
and her neuroimaging and therapeutic approach.

Method: A 23-year-old female began to experience gelastic and complex partial seizures since age
13. Her seizures continued despite trials of multiple anticonvulsant medications.

Results: Neurological examination was normal .The EEGs did not show focal findings. The initial
1.5-Tesla MRI of her brain did not reveal any lesion. Then she did undergo a 3- Tesla MRI scan. This
study demonstrated a 4.8 mm left hypothalamic hamartoma. The patient was referred to Barrow
Neurological institute for surgical treatment of hamartoma and after thorough discussion of her
treatment options was decided to undertake gamma knife stereotactic radiosurgery as less invasive
therapy.

Conclusions: Gelastic epilepsy is a form of epilepsy typically unresponsive to antiepileptic therapy.
In cases of gelastic epilepsy small HHs may not be demonstrated on the 1.5-Teslal MRI. Subsequent
imaging should be performed with 3-Tesla MRI scan. Radiosurgery has been proposed as an
alternative less invasive method for the treatment of hypothalamic hamartoma. In our case the HH
was confirmed with 3-Tesla MRI scan .Gamma Knife radiosurgery was considered to be an ideal
therapeutic option for this patient despite its delay effect, because of the small size of the lesion
and her intact cognitive function.

								
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