Aggression and Psychiatric Comorbidity in Children With Hypothalamic Hamartomas and Their Unaffected Siblings

doi:10.1097/00004583-200106000-00015

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 40, Issue 6, June 2001, Pages 696-703

https://doi.org/10.1097/00004583-200106000-00015 Get rights and content

ABSTRACT

Objective

To assess aggression and psychiatric comorbidity in a sample of children with hypothalamic hamartomas and gelastic seizures and to assess psychiatric diagnoses in siblings of study subjects.

Method

Children with a clinical history of gelastic seizures and hypothalamic hamartomas (n = 12; age range 3–14 years) had diagnoses confirmed by video-EEG and head magnetic resonance imaging. Structured interviews were administered, including the Diagnostic Interview for Children and Adolescents-Revised Parent Form (DICA-R-P), the Test of Broad Cognitive Abilities, and the Vitiello Aggression Scale. Parents were interviewed with the DICA-R-P about each subject and a sibling closest in age without seizures and hypothalamic hamartomas. Patients were seen from 1998 to 2000.

Results

Children with gelastic seizures and hypothalamic hamartomas displayed a statistically significant increase in comorbid psychiatric conditions, including oppositional defiant disorder (83.3%) and attention-deficit/hyperactivity disorder (75%). They also exhibited high rates of conduct disorder (33.3%), speech retardation/learning impairment (33.3%), and anxiety and mood disorders (16.7%). Significant rates of aggression were noted, with 58% of the seizure patients meeting criteria for the affective subtype of aggression and 30.5% having the predatory aggression subtype. Affective aggression was significantly more common (p < .05). Unaffected siblings demonstrated low rates of psychiatric pathology on semistructured parental interview and no aggression as measured by the Vitiello Aggression Scale.

Conclusions

Children with hypothalamic hamartomas and gelastic seizures had high rates of psychiatric comorbidity and aggression. Parents reported that healthy siblings had very low rates of psychiatric pathology and aggression.

Section snippets

Patient Sample and Comparison Sample

The study was approved by the Institutional Review Board of the National Institute of Neurological Disorders and Stroke. The patient sample included 12 children between the ages of 3 and 14 years. Parents gave informed consent for all children participating. Children 7 years of age and older were asked for, and provided, assent to participate in the study. Subjects were recruited from around the United States, mainly from the Hypothalamic Hamartoma With Uncontrolled Gelastic Seizures (HHUGS)

RESULTS

Parents of 10 (83.3%) of the 12 patients with hypothalamic hamartomas reported significant problems of aggression, rage, temper outbursts and tantrums, violence, and other manifestations of emotional lability. Of the two children reported not to be aggressive, only one child had no behavioral abnormalities. A 4-year-old was described as nonaggressive, but demonstrated speech, learning, and communication deficits. Eight patients (66.7%) were receiving anticonvulsant and psychotropic medications

DISCUSSION

The findings of this study of 12 patients with hypothalamic hamartomas and gelastic seizures are as follows: (1) compared with sibling controls, these children demonstrate significantly more expressions of aggression and rage; (2) these expressions of aggression and rage are more affective than predatory in nature; (3) by parent report, these patients demonstrate behaviors that meet DSM-IV criteria for oppositional defiant disorder, ADHD, conduct disorder, and mood and anxiety disorders more

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Hypothalamic hamartomas (HHs) are benign lesions found in 1–2 per 100,000 persons.1,2
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: This paper was edited with the help of Marisa Alter, B.S., Tamar Yemini, B.A., and Lisa Korenman, B.S.

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ArticlesAggression and Psychiatric Comorbidity in Children With Hypothalamic Hamartomas and Their Unaffected Siblings

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Patient Sample and Comparison Sample

RESULTS

DISCUSSION

Electroencephalogr Clin Neurophysiol

Brain Res

Psychiatr Clin North Am

Brain Dev

Electroencephalogr Clin Neurophysiol

Neuropsychiatry

Mol Brain Res

The relationship between magnetic resonance imaging findings and clinical manifestations of hypothalamic hamartomas

J Neurosurg

Subsidence of seizure induced by stereotactic radiation in a patient with hypothalamic hamartoma

J Neurosurg

Mirth, laughter and gelastic seizures

Brain

Hypothalamic hamartomas and ictal laughter: evolution of a characteristic epileptic syndrome and diagnostic value of magnetic resonance imaging

Ann Neurol

Phenobarbital treatment and major depressive disorder in children with epilepsy

Pediatrics

Gelastic seizures and hypothalamic hamartomas: evaluation of patients undergoing chronic intracranial EEG monitoring and outcome of surgical treatment

Neurology

Gelastic epilepsy

Neurology

Special report: the nature of aggression during epileptic seizures

N Engl J Med

Interictal behavioral disturbances: a search for molecular substrates

Epilepsy Res Suppl

Subacute postictal aggression

Neurology

ACTH treatment for gelastic seizures

Arch Dis Child

Hypothalamic astrocytoma: syndrome of hyperphasia, obesity, and disturbances of behavior and endocrine and autonomic function

Arch Neurol

The etiology of aggression in temporal lobe epilepsy

Br J Psychiatry

Gelastic epilepsy: a clinical contribution

Clin Pediatr (Phila)

Articles
Aggression and Psychiatric Comorbidity in Children With Hypothalamic Hamartomas and Their Unaffected Siblings