ReviewPsychiatric comorbidity with hypothalamic hamartoma: Systematic review for predictive clinical features

•Psychiatric comorbidity, consisting of aggression and rage behavior, is common in patients with hypothalamic hamartoma (HH) and epilepsy•Clinical features predictive for aggression in this patient population are unknown•We performed a systematic review of the medical literature and identified two cohorts: those with and without aggression•Presence of aggression was associated with male gender, younger age at time of first seizure, intellectual disability, and multiple seizure types.

ObjectiveWe conducted a systematic review of the English-language literature to identify clinical features associated with a higher risk of psychiatric symptoms (aggression and rage behaviors) in patients with hypothalamic hamartoma (HH) and epilepsy.MethodsTwo publicly-accessible databases (PubMed and Cochrane Library) were searched for Hypothalamic Hamartoma AND Epilepsy. We identified peer-reviewed original research publications (case reports or clinical series; N = 19) in which clinical data was provided on an individual basis. Subjects were cohorted into those with (N = 51) and without (N = 68) behavioral aggression. Multiple clinical features were collated and subjected to univariate analysis to determine possible differences between these two cohorts.ResultsThe presence of aggression significantly correlated with 1) male gender, 2) younger age at time of first seizure onset, 3) the presence of intellectual disability, and 4) the presence of multiple seizure types (versus gelastic seizures only). For those patients undergoing surgical treatment, aggression also correlated with younger age at the time of surgical intervention.ConclusionPossible predictive clinical features for the presence of aggression and rage behaviors in patients with hypothalamic hamartoma and epilepsy are identified. These results may contribute to the complex treatment decisions that are unique to this population.