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[PMID]:29334271
[Au] Autor:Corona G; Rastrelli G; Reisman Y; Sforza A; Maggi M
[Ad] Endereço:a Endocrinology Unit, Medical Department , Maggiore-Bellaria Hospital, Azienda-Usl Bologna , Bologna , Italy.
[Ti] Título:The safety of available treatments of male hypogonadism in organic and functional hypogonadism.
[So] Source:Expert Opin Drug Saf;17(3):277-292, 2018 Mar.
[Is] ISSN:1744-764X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: In the case of primary male hypogonadism (HG), only testosterone (T) replacement therapy (TRT) is possible whereas when the problem is secondary to a pituitary or hypothalamus alteration both T production and fertility can be, theoretically, restored. We here systematically reviewed and discussed the advantages and limits of medications formally approved for the treatment of HG. Areas covered: Data derived from available meta-analyses of placebo controlled randomized trials (RCTs) were considered and analyzed. Gonadotropins are well-toleratedand their use is mainly limited by higher costs and a more cumbersome treatment schedule than TRT. Available RCTs on TRT suggest that cardiovascular (CV) and venous thromboembolism risk is not a major issue and that prostate safety is guaranteed. The risk of increased hematocrit is mainly limited to the use of short terminjectable preparations. Expert opinion: In the last few years the concept of 'organic' irreversible HG and 'functional' or age- and comorbidity-related HG has been introduced. This definition is not evidence-based. The majority of RCTs enrolled patients with 'functional' HG. Considering the significant improvement in body composition, glucose metabolism and sexual activity, TRT should not be limited to 'organic' HG, but also offered for 'functional'.
[Mh] Termos MeSH primário: Gonadotropinas/administração & dosagem
Hipogonadismo/tratamento farmacológico
Testosterona/administração & dosagem
[Mh] Termos MeSH secundário: Gonadotropinas/efeitos adversos
Terapia de Reposição Hormonal/efeitos adversos
Terapia de Reposição Hormonal/métodos
Seres Humanos
Hipogonadismo/etiologia
Doenças Hipotalâmicas/complicações
Infertilidade Masculina/tratamento farmacológico
Infertilidade Masculina/etiologia
Masculino
Doenças da Hipófise/complicações
Ensaios Clínicos Controlados Aleatórios como Assunto
Testosterona/efeitos adversos
Testosterona/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Gonadotropins); 3XMK78S47O (Testosterone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180116
[St] Status:MEDLINE
[do] DOI:10.1080/14740338.2018.1424831


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[PMID]:28463619
[Au] Autor:Brandmeir NJ; Sather MD
[Ad] Endereço:Penn State Health, Milton S. Hershey Medical Center, Hershey, PA.
[Ti] Título:Letter to the Editor. Stereotactic laser ablation for hypothalamic hamartomas after SRS failure.
[So] Source:Neurosurg Focus;42(5):E18, 2017 05.
[Is] ISSN:1092-0684
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hamartoma/cirurgia
Doenças Hipotalâmicas/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Terapia a Laser
Radiocirurgia
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.3171/2016.11.FOCUS16426


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[PMID]:29020588
[Au] Autor:Curran MA; Madhavan VL; Caruso PA; Ebb DH; Williams EA
[Ad] Endereço:From the Departments of Pediatrics (M.A.C., V.L.M., D.H.E.), Radiology (P.A.C.), and Pathology (E.A.W.), Massachusetts General Hospital, and the Departments of Pediatrics (M.A.C., V.L.M., D.H.E.), Radiology (P.A.C.), and Pathology (E.A.W.), Harvard Medical School - both in Boston.
[Ti] Título:Case 31-2017. A 19-Month-Old Girl with Failure to Thrive.
[So] Source:N Engl J Med;377(15):1468-1477, 2017 10 12.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Astrocitoma/diagnóstico por imagem
Insuficiência de Crescimento/etiologia
Neoplasias Hipotalâmicas/diagnóstico por imagem
[Mh] Termos MeSH secundário: Astrocitoma/complicações
Astrocitoma/patologia
Análise Química do Sangue
Caquexia/etiologia
Diagnóstico Diferencial
Ingestão de Energia
Feminino
Seres Humanos
Doenças Hipotalâmicas/diagnóstico
Neoplasias Hipotalâmicas/complicações
Neoplasias Hipotalâmicas/patologia
Lactente
Imagem por Ressonância Magnética
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcpc1706106


  4 / 1695 MEDLINE  
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[PMID]:28720298
[Au] Autor:Dembek KA; Timko KJ; Johnson LM; Hart KA; Barr BS; David B; Burns TA; Toribio RE
[Ad] Endereço:College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA.
[Ti] Título:Steroids, steroid precursors, and neuroactive steroids in critically ill equine neonates.
[So] Source:Vet J;225:42-49, 2017 Jul.
[Is] ISSN:1532-2971
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Hypothalamic-pituitary-adrenal axis (HPAA) dysfunction has been associated with sepsis and mortality in foals. Most studies have focused on cortisol, while other steroids have not been investigated. The objectives of this study were to characterise the adrenal steroid and steroid precursor response to disease and to determine their association with the HPAA response to illness, disease severity, and mortality in hospitalised foals. All foals (n=326) were classified by two scoring systems into three categories: based on the sepsis score (septic, sick non-septic [SNS] and healthy) and the foal survival score (Group 1: 3-18%; Group 2: 38-62%; Group 3: 82-97% likelihood of survival). Blood concentrations of adrenocorticotropic hormone (ACTH) and steroids were determined by immunoassays. ACTH-cortisol imbalance (ACI) was defined as a high ACTH/cortisol ratio. Septic foals had higher ACTH, cortisol, progesterone, 17α-OH-progesterone, pregnenolone, and androstenedione concentrations as well as higher ACTH/cortisol, ACTH/progesterone, ACTH/aldosterone, and ACTH/DHEAS ratios than SNS and healthy foals (P<0.01). Foals with DHEAS of 0.4-5.4ng/mL were more likely to have ACI (OR=2.5). Foals in Group 1 had higher ACTH, aldosterone, progesterone, and cortisol concentrations as well as ACTH/cortisol, ACTH/progesterone, and ACTH/DHEAS ratios than foals in Groups 2 and 3 (P<0.01). High progesterone concentrations were associated with non-survival and the cutoff value below which survival could be predicted was 23.5ng/mL, with 75% sensitivity and 72% specificity. In addition to cortisol, the response to the stress of illness in foals is characterised by the release of multiple adrenal steroids. DHEAS and progesterone were good predictors of HPAA dysfunction and outcome in hospitalised foals.
[Mh] Termos MeSH primário: Animais Recém-Nascidos/sangue
Doenças dos Cavalos/sangue
Doenças Hipotalâmicas/veterinária
Sistema Hipotálamo-Hipofisário/fisiopatologia
Sistema Hipófise-Suprarrenal/fisiopatologia
Esteroides/sangue
[Mh] Termos MeSH secundário: Hormônio Adrenocorticotrópico/sangue
Androstenodiona/sangue
Animais
Estado Terminal
Doenças dos Cavalos/mortalidade
Cavalos
Hidrocortisona/sangue
Doenças Hipotalâmicas/sangue
Pregnenolona/sangue
Progesterona/sangue
Prognóstico
Sepse/veterinária
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Steroids); 409J2J96VR (Androstenedione); 4G7DS2Q64Y (Progesterone); 73R90F7MQ8 (Pregnenolone); 9002-60-2 (Adrenocorticotropic Hormone); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE


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[PMID]:28703275
[Au] Autor:Sonoda M; Masuda H; Shirozu H; Ito Y; Akazawa K; Asano E; Kameyama S
[Ad] Endereço:Hypothalamic Hamartoma Center, Department of Functional Neurosurgery, Nishi-Niigata Chuo National Hospital, Niigata, Japan.
[Ti] Título:Predictors of cognitive function in patients with hypothalamic hamartoma following stereotactic radiofrequency thermocoagulation surgery.
[So] Source:Epilepsia;58(9):1556-1565, 2017 Sep.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo: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.
[Mh] Termos MeSH primário: Transtornos Cognitivos/etiologia
Hamartoma/cirurgia
Doenças Hipotalâmicas/cirurgia
Radiocirurgia/métodos
[Mh] Termos MeSH secundário: Adolescente
Criança
Seres Humanos
Testes Neuropsicológicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13838


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[PMID]:28625907
[Au] Autor:Bertulli L; Bertani GA; Gianelli U; Mantovani G; Rampini PM; Locatelli M
[Ad] Endereço:Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: lorenzo.bertulli@studenti.unimi.it.
[Ti] Título:Long-Standing Isolated Autoimmune Hypothalamitis Diagnosed with Endoscopic Transventricular Biopsy.
[So] Source:World Neurosurg;105:1036.e5-1036.e9, 2017 Sep.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Autoimmune hypothalamitis, which is among the causes of acquired central diabetes insipidus, has seldom been described in the literature. This condition is probably provoked by the production of anti-vasopressin-secreting cell antibodies and antihypothalamus antibodies and is often associated with pituitary or polyendocrine autoimmunity. Correct diagnosis and immediate treatment are essential to avoid the progression of the pathologic process. CASE DESCRIPTION: A woman diagnosed with central diabetes insipidus 12 years ago, who had panhypopituitarism and mild memory deficit, came to our attention. She refused radiologic studies. Magnetic resonance imaging performed in our unit showed a contrast-enhancing hypothalamic lesion. Lumbar puncture was negative for neoplastic markers. We decided to perform a biopsy of the lesion to obtain a histopathologic examination of the tissue and chose an endoscopic transventricular approach to reach the floor of the third ventricle. Autoimmune hypothalamitis was diagnosed and treatment with steroids and azathioprine was started. The lesion size decreased and was stable after 17 months of follow-up. CONCLUSIONS: The endoscopic transventricular approach has proved to be an effective and safe way to obtain tissue samples for histopathologic examination from a region that is usually difficult to reach; it also gives direct visualization of the lesion, which makes sampling easier. The lesion size decreased after treatment but no clinical improvement was detected, either on the cognitive or on the endocrinologic side.
[Mh] Termos MeSH primário: Doenças Autoimunes/diagnóstico
Doenças Autoimunes/cirurgia
Endoscopia/métodos
Doenças Hipotalâmicas/diagnóstico
Doenças Hipotalâmicas/cirurgia
[Mh] Termos MeSH secundário: Idoso
Doenças Autoimunes/complicações
Biópsia
Transtornos Cognitivos/diagnóstico por imagem
Transtornos Cognitivos/etiologia
Diabetes Insípido/fisiopatologia
Feminino
Fluordesoxiglucose F18/farmacocinética
Seres Humanos
Hipopituitarismo/complicações
Hipopituitarismo/diagnóstico por imagem
Hipopituitarismo/etiologia
Doenças Hipotalâmicas/complicações
Antígeno Ki-67/metabolismo
Imagem por Ressonância Magnética
Tomografia por Emissão de Pósitrons
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Ki-67 Antigen); 0Z5B2CJX4D (Fluorodeoxyglucose F18)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE


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[PMID]:28591485
[Au] Autor:Helen Cross J; Spoudeas H
[Ad] Endereço:UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.
[Ti] Título:Medical management and antiepileptic drugs in hypothalamic hamartoma.
[So] Source:Epilepsia;58 Suppl 2:16-21, 2017 Jun.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Hypothalamic hamartoma may present with epilepsy, specifically gelastic or dacrystic seizures, or endocrine dysfunction, commonly precocious puberty. The epilepsy in many patients is drug resistant, and has a high association with progressive cognitive, learning and behavioral difficulty. Medical treatment of seizures remains problematic, with many resistant to drug treatment. Surgical resection, or disconnection of the hamartoma provides the optimal chance of seizure control but with a relatively high risk of endocrine dysfunction, the result of interference with the hypothalamic-pituitary axis in many. Careful assessment and monitoring by specialist centers with discussion of optimal intervention is required for individual cases.
[Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico
Epilepsia Resistente a Medicamentos/tratamento farmacológico
Epilepsias Parciais/tratamento farmacológico
Hamartoma/tratamento farmacológico
Doenças Hipotalâmicas/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Criança
Transtornos do Comportamento Infantil/diagnóstico
Transtornos do Comportamento Infantil/prevenção & controle
Pré-Escolar
Transtornos Cognitivos/diagnóstico
Transtornos Cognitivos/prevenção & controle
Diagnóstico Diferencial
Progressão da Doença
Epilepsia Resistente a Medicamentos/diagnóstico
Eletroencefalografia
Doenças do Sistema Endócrino/diagnóstico
Doenças do Sistema Endócrino/tratamento farmacológico
Epilepsias Parciais/diagnóstico
Hamartoma/diagnóstico
Seres Humanos
Doenças Hipotalâmicas/diagnóstico
Lactente
Recém-Nascido
Imagem por Ressonância Magnética
Masculino
Processamento de Sinais Assistido por Computador
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13758


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[PMID]:28591484
[Au] Autor:Régis J; Lagmari M; Carron R; Hayashi M; McGonigal A; Daquin G; Villeneuve N; Laguitton V; Bartolomei F; Chauvel P
[Ad] Endereço:Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit, INSERM, UMR 1106 and Timone University Hospital, Aix-Marseille University, Marseille, France.
[Ti] Título:Safety and efficacy of Gamma Knife radiosurgery in hypothalamic hamartomas with severe epilepsies: A prospective trial in 48 patients and review of the literature.
[So] Source:Epilepsia;58 Suppl 2:60-71, 2017 Jun.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Epilepsies associated with hypothalamic hamartomas (HHs) are frequently drug resistant with severe psychiatric and cognitive comorbidities. We performed a prospective trial to evaluate the safety and efficacy of Gamma Knife radiosurgery (GKS). Between October 1999 and October 2007, a total of 57 patients were investigated, included and treated by GKS in Timone University Hospital. Preoperative workup and 3-year postoperative evaluation consisted of seizure diary, neuropsychological, psychiatric, endocrinologic, visual field, and visual acuity examinations. Follow-up of >3 years was available for 48 patients. Topologic type was type I in 11 patients, type II in 15, type III in 17, type IV in one, type V in one, type VI in one, and mixed type in 2. The median marginal dose was 17 Gy (min 14 and max 25 Gy). The median target volume was 398 mm (28-1,600 mm ). Due to partial results, 28 patients (58.3%) required a second treatment. The median follow-up was 71 months (36-153 months). At last follow-up, the rate of Engel class I outcome was 39.6%, Engel class II was 29.2% (I+II 68.8%), and Engel class III was 20%. Global psychiatric comorbidity was considered cured in 28%, improved in 56%, stable in 8%, and continued to worsen in 8%. No permanent neurologic side effect was reported (in particular, no memory deficit). Nondisabling transient poikilothermia was observed in three patients (6.2%). A transient increase of seizure frequency was reported in 8 patients (16.6%) with a median duration of 30 days (9-90 days). Microsurgery was proposed because of insufficient efficacy of GKS in seven patients (14.5%) with a postoperative Engel class I-II in 28.6%. This prospective trial demonstrates very good long-term safety and efficacy of GKS for 2 patients. Beyond seizure reduction, the improvement of psychiatric and cognitive comorbidities along with better school performance and social functioning, being better socially integrated, having friends having a social life, working, participating to group activities turn out to be major benefits of GKS in this group of patients with frequently catastrophic epilepsy.
[Mh] Termos MeSH primário: Epilepsia Resistente a Medicamentos/cirurgia
Epilepsias Parciais/cirurgia
Hamartoma/cirurgia
Doenças Hipotalâmicas/cirurgia
Radiocirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Pré-Escolar
Comorbidade
Epilepsia Resistente a Medicamentos/diagnóstico
Epilepsias Parciais/diagnóstico
Feminino
Seguimentos
França
Hamartoma/diagnóstico
Seres Humanos
Doenças Hipotalâmicas/diagnóstico
Masculino
Meia-Idade
Testes Neuropsicológicos
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/etiologia
Estudos Prospectivos
Reoperação
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13754


  9 / 1695 MEDLINE  
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[PMID]:28591482
[Au] Autor:Scholly J; Staack AM; Kahane P; Scavarda D; Régis J; Hirsch E; Bartolomei F
[Ad] Endereço:Medical and Surgical Epilepsy Unit, Hautepierre Hospital, University of Strasbourg, Strasbourg, France.
[Ti] Título:Hypothalamic hamartoma: Epileptogenesis beyond the lesion?
[So] Source:Epilepsia;58 Suppl 2:32-40, 2017 Jun.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The discovery of intrinsic epileptogenicity of the hypothalamic hamartoma (HH) marked a new area in understanding the associated clinical syndrome, often manifesting as progressive epileptic encephalopathy. However, therapeutic procedures targeting the HH proved to be inefficient to cure seizures in up to 50% of cases, whereas in cases with partial improvement, the electroclinical patterns of persisting seizures suggest an involvement of distant cortical regions. The concept of kindling-like secondary epileptogenesis has been suggested as a possible underlying mechanism. Yet the role of the hypothalamic lesion in the pathophysiology of the syndrome remains debatable. In the Strasbourg-Kork series, the best outcomes were obtained when the duration of epilepsy before endoscopic HH surgery did not exceed 10 years. In two patients with HH ablation followed at a later time by a temporal lobectomy, only this second surgical step allowed complete seizure freedom. These findings suggest the existence of an independent, third stage of secondary epileptogenesis in human. In the Grenoble series, stereotactic intracerebral recordings (stereo electroencephalography [SEEG]) of five HH cases demonstrated that gelastic/dacrystic seizures were correlated with discharges within the HH, whereas other seizure types were related to discharges affecting cortical regions, which sometimes seemed to be triggered by HH. In the Marseille series, two cases explored by SEEG provided evidence of extended epileptogenicity outside the limits of the HH, forming complex epileptogenic networks, with HH still triggering clusters of neocortical seizures in the first, but not obligatory involved in spontaneous seizures in the second case. Taken together, our data argue for the existence of dynamic ictal network organization, with possible "kindling-like" relationships between the HH and the neocortex or widespread epileptogenesis. Despite the existence of secondary epileptogenesis, the epileptogenic zone could still be limited to the hamartoma, for which early surgical treatment should be pragmatically considered as a first surgical step.
[Mh] Termos MeSH primário: Epilepsias Parciais/fisiopatologia
Hamartoma/fisiopatologia
Doenças Hipotalâmicas/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Lobectomia Temporal Anterior
Criança
Pré-Escolar
Modelos Animais de Doenças
Progressão da Doença
Dominância Cerebral/fisiologia
Eletrodos Implantados
Eletroencefalografia
Epilepsias Parciais/diagnóstico
Epilepsias Parciais/cirurgia
Feminino
Hamartoma/diagnóstico
Hamartoma/cirurgia
Hipocampo/fisiopatologia
Seres Humanos
Doenças Hipotalâmicas/diagnóstico
Doenças Hipotalâmicas/cirurgia
Excitação Neurológica/fisiologia
Masculino
Neocórtex/fisiopatologia
Neocórtex/cirurgia
Rede Nervosa/fisiopatologia
Rede Nervosa/cirurgia
Neurônios/fisiologia
Processamento de Sinais Assistido por Computador
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13755


  10 / 1695 MEDLINE  
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[PMID]:28591483
[Au] Autor:Wagner K; Wethe JV; Schulze-Bonhage A; Trippel M; Rekate H; Prigatano GP; Kerrigan JF
[Ad] Endereço:Epilepsy Centre, Medical Center - University of Freiburg, Freiburg, Germany.
[Ti] Título:Cognition in epilepsy patients with hypothalamic hamartomas.
[So] Source:Epilepsia;58 Suppl 2:85-93, 2017 Jun.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Many patients with epilepsy caused by hypothalamic hamartomas (HHs) have cognitive impairments during the course of the disease or following neurosurgical treatment. The purpose of this study was to assess cognitive function in these patients, as well as factors influencing preoperative cognitive performance and cognitive outcome after neurosurgical treatment. Using the two largest and most detailed neuropsychology datasets on HH and epilepsy from two centers, we retrospectively report on cognitive functions in 48 patients with structural epilepsy due to HH (mean age ± standard deviation [SD] 20 ± 12 years, range 5-53 years, median 16 years; disease duration mean 17 ± 11 years). Intelligence, verbal learning and recall, and speed and executive functions (processing speed and cognitive flexibility) were assessed before and on average 19 (±11) months after surgery (interstitial radiosurgery: N = 22; neurosurgical resection/disconnection: N = 26). Prior to neurosurgical treatment, 52% of patients showed impaired executive and 62% showed reduced verbal memory functions. A trend for a detrimental effect of higher drug load on cognitive functioning was found. After neurosurgical treatment, intellectual functions for the entire cohort tended to increase. This correlated with improved seizure frequency and decreased number of antiepileptic drugs (AEDs). However, postoperative outcomes for individual patients were highly variable, with significant deteriorations in 17% (processing speed) to 34% (cognitive flexibility and verbal learning), and performance increases in 17% (intellectual functioning) up to 39% (processing speed) of the patients. Higher levels of presurgical performance were significant predictors of cognitive decline after surgery. These results are highly relevant for patient consultation and may help with therapeutic decisions.
[Mh] Termos MeSH primário: Transtornos Cognitivos/diagnóstico
Epilepsia Resistente a Medicamentos/cirurgia
Epilepsias Parciais/diagnóstico
Hamartoma/diagnóstico
Doenças Hipotalâmicas/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Pré-Escolar
Transtornos Cognitivos/cirurgia
Epilepsia Resistente a Medicamentos/diagnóstico
Epilepsias Parciais/cirurgia
Função Executiva
Feminino
Seguimentos
Hamartoma/cirurgia
Seres Humanos
Doenças Hipotalâmicas/cirurgia
Masculino
Memória de Curto Prazo
Meia-Idade
Testes Neuropsicológicos/estatística & dados numéricos
Complicações Pós-Operatórias/diagnóstico
Psicometria
Tempo de Reação
Fatores de Risco
Aprendizagem Verbal
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13759



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