Epilepsy surgery in children with developmental tumours

Abstract

We report our experience regarding evaluation, surgical treatment and outcomes in a population of 21 children with histopathologically confirmed developmental tumours [nine dysembryoplastic neuroepithelial tumours (DNET), ten gangliogliomas (GG) and two gangliocytomas (GC)] and related epilepsy, analyzing video-EEG, MRI and neuropsychological data, before and after surgery. Most children had focal epilepsy correlating well with lesion location. One patient had epileptic spasms and generalized discharges. Tumours were located in the temporal lobe in 13 patients. Mean age at surgery was 11.16 years. Postsurgical MRI showed residual tumour growth in one DNET. One child had a recurrent ganglioglioma with anaplastic transformation. At latest follow-up (mean 4.68 years) 95.2% of patients were seizure-free and no significant neuropsychological declines were observed. Evidence from our study suggests that, in this setting, surgery should be performed before criteria for refractory epilepsy are met, particularly in cases with early seizure onset, in order to optimize cognitive outcome.

Seizure outcomes in children with epilepsy after resective brain surgery

“…The treatment plan has to be individualized. 32, 33 We agree with Garcia-Fernandez et al 15 that surgery should be considered early in children with brain tumours especially the developmental tumours, even before the epilepsy is defined as being refractory to AEDs, in order to maximise the benefit from surgery.…”

“…The seizure outcome in our cohort is better than that reported in some of the other studies 16,31 and more akin to the experience of Garcia-Fernandez et al 15 and Babini et al 8 In patients with brain tumour, seizures at the onset are seen in 20e40% while a further 20e45% will have seizures during the course of their disease. The management of seizures in brain tumour related epilepsy is often complex and has to be undertaken in the context of a child on multiple other interventions and medications.…”

Seizure outcome of surgical treatment of focal epilepsy associated with low-grade tumors in children

“…We believe that, especially for epilepsy-associated LGTs located in noneloquent areas, surgery should be offered early regardless of the response to medical treatment either for a better seizure outcome 14,20,22,37,56 or to minimize risks of tumor growth or malignant transformation. 12,23,29,49,54,67 …”

Epilepsy-associated tumours: what epileptologists should know about neuropathology, terminology, and classification systems

“…It is also puzzling and difficult to understand why there are such different percentages of LEAT subtypes in published surgical series, which some authors refer to as “geographical differences” ( see review of Thom et al ., ). The majority of publications on epilepsy‐associated brain tumours specify GGs as the most frequent tumour type, followed by DNTs and PAs (Khajavi et al ., ; Luyken et al ., ; Zaatreh et al ., ; Brainer‐Lima et al ., ; Schramm and Aliashkevich, ; Sugano et al ., ; Ruban et al ., ; Prayson, ; Garcia‐Fernandez et al ., ; Babini et al ., ; Cossu et al ., ; Rydenhag et al ., ; Fallah et al ., ; Bonney et al ., , ). However, even in large series, the frequency of GGs can vary from 6% to 49%, and for DNTs from even 7% to 80% (Thom et al ., ).…”