International Consensus on the Evaluation and Management of Hypothalamic Hamartomas: Results From a Modified Delphi Survey - PubMed

7 hours ago

Hypothalamic hamartomas (HH) are rare brain lesions linked to epilepsy and various comorbidities.
A modified Delphi survey was conducted among 17 epilepsy surgery centers to establish expert consensus on HH management.
Consensus was achieved on 82% of the questions, covering diagnosis, imaging, treatment, and postoperative care.
Key diagnostic findings: Gelastic and dacrystic seizures are strongly associated with HH; 3T epilepsy protocol MRI is essential.
Evaluation: Preoperative neuropsychological and endocrinologic assessments are important, but further imaging (PET, SPECT, MEG) and intracranial EEG are not useful.
Treatment: No consensus on first-line antiseizure medications (ASMs). Surgery is recommended after failure of 2 ASMs, with LITT preferred for Delalande II and III HH.
Postoperative care: MRI follow-up at 6-12 months is recommended, along with cognitive, behavioral, and endocrinologic evaluations.
Important domains for evaluation include IQ, language, attention, executive function, academic achievement, adaptive function, and behavior.
Early epilepsy surgery evaluation is advised, with surgery techniques depending on HH location, size, and surgical experience.
Areas lacking consensus, such as specific endocrine testing and timing of interventions, require further research.

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