Refractory epilepsy in children with brain tumors. The urgency of neurosurgery

Abstract

In order to verify indications for surgery, 27 patients with refractory epileptic seizures and brain tumor, aged up to 19 years at the time of surgery, were studied between 1996 and 2013 and followed up for at least one year. The mean interval between the onset of seizures and the diagnosis of the tumor was 3.6 years, and from diagnosis to the surgery, 18 months. The location of the tumor was in the temporal lobe in 16, with ganglioglioma and dysembryoplastic neuroepithelial tumors being the most frequent. Among the patients, 92.5% and 90.4% were seizure-free in the first and fifth year after surgery, respectively. Twelve of 16 children were successful in becoming drug-free, with complete withdrawal by 3.2 years. Surgery proved to be potentially curative and safe in these cases, suggesting that the tumor diagnosis and surgery cannot be postponed.

Seizures in Children With Low Grade Glioma

“…15 Among supratentorial locations temporal lobe (59.3) was most common followed by parietal lobe (25.9) in another study of children with refractory epilepsy operated for brain tumor. 5 Temporal lobe (51.9%) and frontal lobe (31.5%) predominated in another study on seizures in children with brain tumors. 14 Tumor recurrence is another risk factor for seizure appearance or recurrence during follow up.…”

“…Among others oligodendroglioma was most frequently seen (11%). 5 Luyken et al have described long-term epilepsy associated tumors (LEAT) in their series of patients with supratentorial tumors operated for refractory epilepsy. This was a mixed age group cohort and children were not analyzed separately.…”

“…13 As high as 96% of tumors operated for refractory epilepsy were supratentorial in one study. 5 So where as presence of seizures points strongly to cortical tumor, it does not rule out infratentorial tumors. Among cortical locations temporal lobe tumors are more often responsible for seizures compared to other lobes.…”

“…16 Similar seizure frequency preoperatively in children with refractory epilepsy and brain tumor was reported as daily in 48%, weekly in 41% and monthly in 11%. 5 The neuronal networks in developing brain of children is constantly evolving and so semiology of seizures is not typical of adult types and varies with age of the child. As expected focal seizures originating from tumor focus are common.…”

“…The proportion of children with simple partial seizures and generalized tonic clonic seizures was rather small (7 % each). 5 There is a large variation in histopathological characteristics of tumors lumped under the category of low grade glioma. Regardless of subtype, tumors located in temporal lobe are more apt at recruiting epileptogenic networks.…”