Childhood brain tumors presenting as chronic uncontrolled focal seizure disorders

Blume, Warren T.; Girivin, John P.; Kaufmann, J. C. E.

doi:10.1002/ana.410120606

Cited by 113 publications

(52 citation statements)

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“…Other authors (5,6,(8)(9)(10)(11)17) also describe lobectomies containing the lesion. Blume et al (20) and Fried and Cascino (19) stated that it is possible to control seizures even when resection of the cerebral lesion is partial, if resection of the irritative area, as identified by ECoG is also performed. Although seizure control may be achieved by partial resection, total resection is desirable, for there may be potentially malignant tumors (19).…”

Section: Discussionmentioning

confidence: 99%

Patients with Epileptic Seizures and Cerebral Lesions Who Underwent Lesionectomy Restricted to or Associated with the Adjacent Irritative Area

et al. 1999

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Summary:Purpose: To analyze the best surgical procedure for patients with epileptic seizures and cerebral lesions-i.e., resection restricted to the lesion or resection associated with the adjacent irritative area-based on the clinical evolution of patients' seizure outcome and electroencephalographic (EEG) and electrocorticographic (ECoG) findings.Methods: This study comprised 37 patients with epileptic seizures and cerebral lesions, ranging in age from 9 to 66 years. Patients were divided into two groups: Group 1 consisted of 21 patients with medically intractable epilepsy, Group 2 of 16 patients with medically controlled epilepsy. Eleven of the 21 patients in Group 1 (Subgroup A) underwent surgical resection of the cerebral lesion and adjacent irritative area as shown by ECoG. For the remaining 10 patients in Group 1 (Subgroup B), the resection was restricted to the lesion. The 16 patients in Group 2 all underwent lesionectomies.Results: Of the 11 patients in group 1 who underwent resection of the cerebral lesion and adjacent irritative area, 91% became seizure free. Sixty percent of the remaining patients in group 1 whose resections were restricted to the lesion also became seizure free, as did all the patients in group 2. An overall analysis of the EEGs for all patients showed a statistically significant decrease in paroxysmal activity.Conclusions: In patients with uncontrolled seizures, resection of the cerebral lesion associated with the irritative area shows a tendency to obtain better seizure-outcome results than restricted lesionectomy. Key Words: Epilepsy tumors-Epilepsy surgery-Lesionectomy-Electrocorticography .In 1887, Victor Horsley [as summarized by Taylor (l)] operated on a patient with partial motor seizures caused by a cerebral tuberculoma. The surgery resulted in a significant reduction in the patient's seizures, supporting a relationship between the lesion and the development of seizures. According to Foerster & Penfield ( 2 ) , the correlation between an irritative brain area and cortical scars caused by head trauma was associated with a good prognosis for control of seizures when the scars were surgically removed. Some authors, such as Falconer and Cavanagh (3) and Rasmussen (4), began additional procedures for surgery of cerebral lesions, not only to remove tumors and arteriovenous malformations (AVM), but not only tumoral resections but also lobectomies on the area that contained the lesion. Rasmussen (4) and Yeh et al.(1 2) sought to locate the irritative area [i.e., the cortical region that contains the epileptogenous area, as defined by Luders and Awad (13)] through electrocorticography (ECoG) and to perform the lesionectomy associated with the adjacent irritative area. Our objective was to analyze whether restricted lesionectomy or lesionectomy with resection of the adjacent irritative cortex is the best approach to treating patients with epileptic seizures and focal cerebral lesions, based on surgical outcome. PATIENTS AND METHODSalso to relieve patients from epileptic seizures. Thus...

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Section: Discussionmentioning

confidence: 99%

Patients with Epileptic Seizures and Cerebral Lesions Who Underwent Lesionectomy Restricted to or Associated with the Adjacent Irritative Area

et al. 1999

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“…It is now recognized that epilepsy related to an underlying structural lesion is poorly responsive to medication, and is unlikely to be cured spontaneously. [2,12,31,37,39,42,44,55,68,72,80,82] Recent advances in neuroradiology allow more frequent identification and better definition of a lesion in children who suffer from partial seizures. [17] Low-grade tumors, dysplastic lesions, focal neuronal migration disorders, vascular malformations, and secondary scar lesions are all important etiological factors in children with partial seizure disorders.…”

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Surgery in epilepsy associated with focal lesions in childhood

Bourgeois¹,

Sainte‐Rose²,

Lellouch‐Tubiana³

et al. 1999

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Surgery in children with epilepsy is a new, evolving field. The important practical issues have been to define strategies for choosing the most suitable candidates, as well as the type and the optimum timing of epilepsy surgery. This study was undertaken to illustrate these points. To identify the factors that correlated with outcome, the authors analyzed a series of 200 children (aged 1–15 years, mean 8.7 years) who underwent surgery at the Hôpital Necker-Enfants Malades between 1981 and 1996. In 171 cases (85.5%) the epilepsy was medically refractory and was associated with focal cortical lesions. Surgery consisted of resection of the lesion without specifically attempting to identify and remove the "epileptogenic area." In the group of children whose seizures were medically refractory, the mean follow-up period was 5.8 years. According to Engel's classification, 71.3% of these children became seizure free (Ia), whereas 82% were in Class I. A multivariate statistical analysis revealed that among all the factors studied, the success of surgery in a patient in whom there was a good clinical-electroencephalogram-imaging correlation, depended on the patients' having undergone a minimally traumatic operation, a complete resection of the lesion, and a short preoperative seizure duration. After the surgical control of epilepsy, behavior disorders were more improved (31% of all patients) than cognitive function (25%). The patient age at onset, duration and frequency of seizures, intractability of the disease to therapy, and seizure characteristics, were correlated with cognitive, behavioral, and academic performance pre- and postoperatively. Multivariate statistical analysis revealed that cognitive dysfunction correlated highly with the duration of epilepsy prior to surgery, whereas behavioral disorders correlated more with seizure frequency. These data must be taken into account when selecting patients for surgical treatment and when deciding the timing of surgery. Early surgical intervention allows for optimum brain development.

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“…At this stage, the secondary focus demonstrates independence from the primary site and secondary epileptogenesis has been established. Tumors frequently induce epileptogenic discharges in the vicinity of the neoplasm, and in some cases, can cause secondary epileptogenic areas in synaptically related sites [2][3][4] . In tumor cases, the likehood that a similar lesion may have arisen at a contralateral homotopic site is remote 2,5,6 .…”

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The role of mirror focus in the surgical outcome of patients with indolent temporal lobe tumors

Sampaio

Yacubian

Manreza

2004

Arq. Neuro-Psiquiatr.

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-Purpose: To review the clinical and neurophysiological data of 21 patients with epilepsy due to temporal lobe tumors and who had undergone evaluation and surgery at the Hospital das Clínicas da Universidade de São Paulo. The aim of this study was to investigate whether the occurrence of a mirror focus was influenced either by certain clinical factors or if the surgical outcome was influenced by the presence of a mirror focus. Method: We included these 21 patients who had undergone at least one interictal electroencephalogram in the pre-and post-surgical periods. They had had a minimum follow-up of one year. Results: Eight patients had mirror focus (Group 1) and 13 did not (Group 2). The mean age at seizure onset, duration of epilepsy disorder and total number of seizures did not vary statistically between the two groups of patients. Generalized tonic-clonic seizures occurred more frequently in the mirror focus group. All, but one patient, with a mirror focus were seizure free at follow-up. The mirror focus disappeared in all eight patients in the post-surgical electroencephalogram. In this group, the patient who was not seizure -free had a seizure recorded in his post-surgical electroencephalogram with seizure onset ipsilateral to the resected tumor. The patients who were not seizure-free had either been submitted to an incomplete resection of the tumor or showed evidence of associated cortical dysplasia. Conclusion: The occurrence of mirror focus is not a contraindication to surgery even when interictal epileptiform activity predominates contralaterally to the tumor and neither when seizures appear to arise from the mirror focus on scalp EEG. Good surgical outcome is expected despite EEG findings that may conflict with tumor location.KEY WORDS: epilepsy, secondary epileptogenesis, electroencephalography, complex partial seizures, temporal lobe tumors.Epilepsia do lobo temporal por processos expansivos e epileptogênese secundária RESUMO -Introdução: A epileptogênese secundária é descrita como fenômeno em que, uma área epileptogênica primária, geradora de descargas, através de conexões neuroniais com outra área não acometida, pode gradualmente induzir alterações epileptiformes nessa última, que, na maioria das vezes se localiza em região homóloga no hemisfério oposto ao foco primário. Objetivos: Analisar em um grupo de 21 pacientes com processos expansivos do lobo temporal e epilepsia a ocorrência do foco em espelho e os fatores clíni-cos potencialmente responsáveis pelo seu desenvolvimento e sua influência no prognóstico cirúrgico. Método: Foram incluídos 21 pacientes que realizaram eletroencefalograma no período interictal, antes e após o tratamento cirúrgico. Dentre os fatores clínicos estudados destaca-se a idade de início e duração da epilepsia bem como a freqüência de crises epilépticas, por serem considerados relevantes no processo da epileptogênese secundária. Resultados: Os pacientes foram divididos em dois grupos de acordo com a presença (8 pacientes) ou não do foco em espelho (13 pacientes). ...

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Childhood brain tumors presenting as chronic uncontrolled focal seizure disorders

Cited by 113 publications

References 7 publications

Patients with Epileptic Seizures and Cerebral Lesions Who Underwent Lesionectomy Restricted to or Associated with the Adjacent Irritative Area

Patients with Epileptic Seizures and Cerebral Lesions Who Underwent Lesionectomy Restricted to or Associated with the Adjacent Irritative Area

Surgery in epilepsy associated with focal lesions in childhood

The role of mirror focus in the surgical outcome of patients with indolent temporal lobe tumors

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