Early and late epilepsy surgery in focal epilepsies associated with long-term epilepsy-associated tumors

Abstract

OBJECTIVE Epilepsy surgery is an effective means of treating focal epilepsy associated with long-term epilepsy-associated tumors. This study evaluated a large population of surgically treated patients with childhood onset of epilepsy and a histologically confirmed diagnosis of long-term epilepsy-associated tumors. The authors analyzed long-term seizure outcomes to establish whether the time of surgery and patients' ages were determinant factors. METHODS The authors separately investigated several presurgical, surgical, and postsurgical variables in patients operated on before (pediatric group) and at or after (adult group) the age of 18 years. Patients with < 24 months of postsurgical follow-up were excluded from the analysis. RESULTS The patients who underwent surgery before 18 years of age showed better seizure outcomes than those after 18 years of age (80% vs 53.3% Engel Class Ia outcome, respectively; p < 0.001). Multivariate analysis showed that the only variables significantly associated with seizure freedom were complete resection of the lesion, a shorter duration of epilepsy, and temporal lobe resection. CONCLUSIONS The findings of this study indicate that pediatric patients are more responsive to epilepsy surgery and that a shorter duration of epilepsy, complete resection, and a temporal lobe localization are determinant factors for a positive seizure outcome.

Localization yield and seizure outcome in patients undergoing bilateral SEEG exploration

“…When pooling multiple lesion types, completeness of lesionectomy has been correlated with seizure freedom in one large cohort of SEEG-guided resections. 3 Indeed, completeness of lesionectomy has classically been associated with seizure freedom in the setting of epilepsy-associated tumors, 30 FCD, 31,32 cavernoma, 33 and posttraumatic encephalomalacia involving the frontal lobe. 34 However, completeness of lesionectomy has not been shown to correlate with seizure freedom in other lesion types such as polymicrogyria 3,15 and PNH.…”

Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”: A retrospective nationwide Italian study

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] For this group of tumors the acronym "LEATs" (longterm epilepsy associated tumors) was proposed by Luyken et al 1 By definition, "long term" means causing drug-resistant seizures for 2 years or more. [1][2][3][4][5][6][7][8][9][10][11][12][13] For this group of tumors the acronym "LEATs" (longterm epilepsy associated tumors) was proposed by Luyken et al 1 By definition, "long term" means causing drug-resistant seizures for 2 years or more.…”

“…6,7,12,[14][15][16][17][18] Accordingly, it has been recently proposed to maintain the acronym LEATs, changing its meaning to "low grade epilepsy associated neuroepithelial tumors." 6,7,12,[14][15][16][17][18] Accordingly, it has been recently proposed to maintain the acronym LEATs, changing its meaning to "low grade epilepsy associated neuroepithelial tumors."…”

“…On the other hand, assessment of drug responsiveness may necessitate at least 1 year of observation. 6,7,12,[14][15][16][17][18]23 In fact, although LEATs are usually considered to have a benign indolent behavior, several reports have demonstrated that gangliogliomas (GGs) 3,9,13 and some glial tumors, such as pleomorphic xanthoastrocytoma (PXA), 3,24 may exhibit an evolving course or malignant transformation. 22 Furthermore, in the field of LEATs, where a correct histologic and molecular diagnosis is increasingly important, avoiding loss of time is essential, for epileptologic, neuropsychological, and oncologic reasons.…”

Dysembryoplastic neuroepithelial tumor (DNET) and focal cortical dysplasia: Case report of two pediatric patients with imaging features

“…[8] Pelliccia et al reported that pediatric patients are more responsive to epilepsy surgery than adults. [9] Their analysis also found that temporal lobe localization, complete resection and shorter duration of epilepsy were the determinant factors for a favorable postoperative seizure outcome. Their findings also supported the early removal of LEATs to achieve better seizure freedom and improve cognitive development.…”