OBJECTIVE: Hypothalamic hamartomas (HHs) are associated with pharmacoresistant epilepsy. Stereotactic radiofrequency thermocoagulation (SRT) shows promise as a disconnecting intervention. Although magnetic resonance imaging (MRI) is typically used to determine the attachment and intervention side, it presents challenges in cases of bilaterally attached HH, where the epileptogenic side is unclear. The lateralizing potential of electroclinical parameters in such cases remains uncertain. This retrospective study evaluates the lateralization value of specific parameters, particularly in patients with unilateral HH, to improve future diagnostics and treatment approaches for bilateral HH. METHODS: Four lateralizing parameters-semiology, ictal electroencephalography (EEG), and interictal epileptiform discharges during awake (IEDs RESULTS: We included 25 patients (2-55 years of age) with mainly unilateral (n = 22) HHs who underwent SRT and presurgical evaluation. All parameters correlated with HH attachment side (semiology R = -.62, p = .005
ictal EEG R = .51, p = .047
IED SIGNIFICANCE: IEDs