{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:42:07Z","timestamp":1790196127804,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"s9","license":[{"start":{"date-parts":[[2013,12,12]],"date-time":"2013-12-12T00:00:00Z","timestamp":1386806400000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Gelastic seizures associated with hypothalamic hamartomas (<jats:styled-content style=\"fixed-case\">HH<\/jats:styled-content>s) are a clinicoradiologic syndrome presenting with a variety of symptoms, including pharmacoresistant epilepsy with multiple seizure types, electroencephalography (<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>) abnormalities, precocious puberty, behavioral disturbances, and progressive cognitive deterioration. Surgery in adults provides seizure freedom in only one third of patients. The poor results of epilepsy surgery could be explained by an extrahypothalamic epileptogenic zone. The existence of an independent, secondary epileptogenic area with persistent seizures after resection of the presumably primary lesion supports the concept of a \u201chypothalamic plus\u201d epilepsy. \u201cHypothalamic plus\u201d epilepsy could be related to either an extrahypothalamic structural lesion (visible on magnetic resonance imaging [<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>] or on neuropathology) or if the former is absent, to a functional alteration with enhanced epileptogenic properties due to a process termed secondary epileptogenesis. We report two patients with gelastic seizures with <jats:styled-content style=\"fixed-case\">HH<\/jats:styled-content> (gelastic seizures isolated or associated with dyscognitive seizures of temporal origin). Both patients underwent two\u2010step surgery: first an endoscopic resection of the <jats:styled-content style=\"fixed-case\">HH<\/jats:styled-content>, followed at a later time by temporal lobectomy. Both patients became seizure\u2010free only after the temporal lobectomy. In both cases, neuropathology failed to demonstrate a significant structural lesion in the temporal lobe. To our knowledge, for the first time, these two cases suggest the existence of independent secondary epileptogenesis in humans.<\/jats:p>","DOI":"10.1111\/epi.12456","type":"journal-article","created":{"date-parts":[[2013,12,13]],"date-time":"2013-12-13T04:55:40Z","timestamp":1386910540000},"page":"123-128","source":"Crossref","is-referenced-by-count":40,"title":["Hypothalamic hamartoma: Is the epileptogenic zone always hypothalamic? Arguments for independent (third stage) secondary epileptogenesis"],"prefix":"10.1111","volume":"54","author":[{"given":"Julia","family":"Scholly","sequence":"first","affiliation":[{"name":"Medical and Surgical Epilepsy Unit University of Strasbourg Strasbourg France"},{"name":"Kork Epilepsy Center Kehl\u2010Kork Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria\u2010Paola","family":"Valenti","sequence":"additional","affiliation":[{"name":"Medical and Surgical Epilepsy Unit University of Strasbourg Strasbourg France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke M.","family":"Staack","sequence":"additional","affiliation":[{"name":"Kork Epilepsy Center Kehl\u2010Kork Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Strobl","sequence":"additional","affiliation":[{"name":"Kork Epilepsy Center Kehl\u2010Kork Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Bast","sequence":"additional","affiliation":[{"name":"Kork Epilepsy Center Kehl\u2010Kork Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Kehrli","sequence":"additional","affiliation":[{"name":"Medical and Surgical Epilepsy Unit University of Strasbourg Strasbourg France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard J.","family":"Steinhoff","sequence":"additional","affiliation":[{"name":"Kork Epilepsy Center Kehl\u2010Kork Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edouard","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Medical and Surgical Epilepsy Unit University of Strasbourg Strasbourg France"},{"name":"Federation of Translational Medicine Epilepsy Center Strasbourg France"},{"name":"IDEE Institute of Epilepsies of Childhood and Adolescence Lyon 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