Appetite and body weight changes after MR-guided laser interstitial thermal therapy of hypothalamic hamartomas in children with drug-resistant epilepsy.

BACKGROUND MR-guided laser interstitial thermal therapy (MRg-LiTT) is a relatively new and minimally invasive surgical treatment for hypothalamic hamartomas. We investigated the prevalence and 1-year outcome of appetite and body weight changes in pediatric patients with drug-resistant hypothalamic hamartoma related epilepsy undergoing MRg-LiTT.

METHODS We retrospectively reviewed consecutive pediatric patients with hypothalamic hamartoma related epilepsy undergoing MRg-LiTT at Great Ormond Street Hospital for children between 2019 and 2024. Relevant clinical data were abstracted by review of the electronic patient record. Qualitative data from 1-year post MRg-LiTT were obtained by patient/parental experience telephone interview.

RESULTS 28 patients (9 female) were identified. Median age was6 years (0.5-16 years)at the time of surgery. Baseline Body Mass Index (BMI) data were available for 26 patients. Baseline median BMI z-score was 1.485 (IQR 0.2, 2.11). Prior to surgery 15/26(57.7%) patients were classified as overweight or obese based on BMI. A total of 16 out of 28 (57.1%) patients experienced an increase in their appetite after surgery. The odds of post-operative increased appetite were significantly lower for patients with autism (p = 0.049)and significantly higher among patients in whom healthy hypothalamus was impacted by ablation (p = 0.03).At 12 months after surgery, BMI data were available for 15 patients. Median BMI z-score at 12 months was 1.89 (IQR 1.22, 2.73). Of those 15 patients, 4 saw an increase in their BMI category (2 from normal to obesity, 1 from normal to overweight, 1 from overweight to obesity) and 3 saw a decrease (2 from obesity to overweight and 1 from overweight to normal). Telephone interviews revealed that affected patients and carers faced significant challenges when dealing with appetite increase and weight gain.

CONCLUSION Transient post-operative increased appetite is a frequent adverse event among pediatric patients with hypothalamic hamartomas undergoing MRg-LiTT as treatment of drug-resistant epilepsy. Persistent weight change is less commonly seen. Dietary support should be an integrated part of pre-operative counselling.