Seizures as the presenting symptom of brain tumours in children

Abstract

Seizures were the presenting clinical symptom in 10 (12%) of 81 consecutive children with a primary brain tumour treated in a tertiary paediatric oncology unit over 5 years. Nine patients experienced partial seizures, and in seven a waking electroencephalogram showed focal or lateralising abnormalities. Astrocytoma was the most common tumour histology. The delay in tumour diagnosis from the onset of seizures ranged from 2 weeks to 2 years with a mean of 6 months. Complete resection of the tumour was the only treatment in three patients and four underwent resection followed by radiotherapy and/or chemotherapy. Two patients died. Three patients became seizure free receiving no antiepileptic medication and the remaining five showed a 50-80% reduction in seizures between 2 and almost 5 years following treatment.

Brain tumor epilepsy: A reappraisal and six remaining issues to be debated

“…Brain tumors could even be more frequent in children with temporal lobe epilepsy, as suggested by surgical case series (Sinclair, Wheatley et al 2001). However, seizure are uncommon as a revealing mode of brain tumors in children, accounting for only 10,2% of a case series, where over symptoms appeared to predate epilepsy (Ibrahim and Appleton 2004). On the other hand, among children under age 3, epilepsy could represent a major mode of revelation (71%) in patients with hemispheric supratential tumors (Gaggero, Consales et al 2009) Even at end-of-life period, epilepsy is consistently reported (Krouwer, Pallagi et al 2000), affecting about 30% of patients according to a study of 324 patients with brain tumor in a palliative care unit (Pace, Di Lorenzo et al 2009).…”

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

“…Early seizures may be generalized, simple partial, complex partial, or mixed, depending upon the tumour's size, location, level of aggressiveness, and other factors [24,26,27,33,34,37,70,74,77,82,87,[110][111][112][113][114][115]. This being said, among children, seizures as a presenting symptom of brain tumour are most commonly complex or simple partial, versus generalized, with complex partial seizures generally accounting for from 50% to as high as 85% of all new-onset seizures [32,63,69,86,[115][116][117].…”

“…In one study reported by Ibrahim et al, for example, the time from seizure onset to tumour diagnosis among ten children presenting with seizures ranged from two weeks to two years, averaging six months [37]. A wide range of opinions and practices exist regarding how aggressive to pursue diagnostic imaging in children presenting with seizures [36,41,51,79,80,100,[127][128][129][130][131][132][133].…”

“…This is largely due to the infratentorial location of the majority of paediatric tumours, where very few are epileptogenic [37]. As such, only a small minority of children and adolescents with a brain tumour will likely ever require an AED, and almost all will have a supratentorial lesion.…”

“…Seizures even increase a paediatric survivor's risk of suicide into adulthood [31]. In addition, there is a subset of children, up to 50% [32], whose low-grade brain cancer presents as seizures [26,[32][33][34][35][36][37][38][39][40][41][42]. Though the vast majority of epileptogenic tumours are supratentorial, some are not, especially among children in whom infratentorial tumours generally comprise the majority [43,44], and in less typical locations like the thalamus and hypothalamus [38,[45][46][47].…”