Chronic electric stimulation in a preschool-aged girl with hypothalamic hamartoma and epilepsy

Aim: This study aimed to report the first case of deep brain stimulation (DBS) in a preschool-aged child with hypothalamic hamartoma (HH) and discuss the rationale and outcome of this treatment. Methods: A 5.5-year-old girl was diagnosed with HH and intractable epilepsy, including laughing seizures, tonic seizures, and atypical absence seizures, using magnetic resonance imaging and electroencephalograph examination, quality of life (QOL), intelligence quotient (IQ), and memory quotient (MQ) tests. A right trans-temporal lobe approach HH stimulation was performed with a quadripolar electrode along the axial plane of the lesion. The initial stimulation parameters were a wave width of 90 μs, a stimulating frequency of 130 Hz, a voltage of 0.5 V, and a maintenance stimulation voltage of 2.0 V. Results: The girl achieved freedom from tonic seizure after 4 months of stimulation (1.5 V), freedom from laughing seizure after 7 months of stimulation (1.8 V), and a reduction by more than 80% of atypical absence seizure after implantation of the stimulation electrode. At the 18-month follow-up visit, the postoperative QOL, IQ, and MQ scores of the girl had improved more than 10% compared with the preoperative scores. There were no surgical- or stimulation-related complications. Conclusion: DBS is a safe and efficient approach in older preschool-aged patients with HH, and it provided freedom from tonic and laughing seizures, as well as a significant reduction of atypical absence seizure and improvement of IQ, MQ. and QOL.