Seizures following surgery for supratentorial extratemporal low-grade tumors in children: a multicenter retrospective study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Resection of brain tumors may lead to new-onset seizures but may also reduce seizure rates in patients presenting with seizures. Seizures are seen at presentation in about 24% of patients with brain tumors. For lesional epilepsy in general, early resection is associated with improved seizure control. However, the literature is limited regarding the occurrence of new-onset postoperative seizures, or rates of seizure control in those presenting with seizures, following resections of extratemporal low-grade gliomas (LGGs) in children.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Data were collected retrospectively from 4 large tertiary centers for children (&lt; 18 years of age) who underwent resection of a supratentorial extratemporal (STET) LGG. The patients were divided into 4 groups based on preoperative seizure history: no seizures, up to 2 seizures, more than 2 seizures, and uncontrolled or refractory epilepsy. The authors analyzed the postoperative occurrence of seizures and the need for antiepileptic drugs (AEDs) over time for the various subgroups.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The study included 98 children. Thirty patients had no preoperative seizures, 18 had up to 2, 16 had more than 2, and 34 had refractory or uncontrolled epilepsy. The risk for future seizures was higher if the patient had seizures within 1 month of surgery. The risk for new-onset seizures among patients with no seizures prior to surgery was low. The rate of seizures decreased over time for children with uncontrolled or refractory seizures. The need for AEDs was higher in the more active preoperative seizure groups; however, it decreased with time.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The resection of STET LGGs in children is associated with a low rate of postoperative new-onset epilepsy. For children with preoperative seizures, even with uncontrolled epilepsy, most have a significant improvement in the seizure activity, and many may be weaned off their AEDs.</jats:p></jats:sec>

Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas

“…In addition, patients with a history of seizures at presentation were less likely to achieve seizure freedom. These results mirror those of a previous multi-site pediatric study [ 27 ].…”

“…The models in which seizure freedom is assessed have varied between studies. Pediatric population studies report post-operative seizure occurrence prior to one week [ 27 , 28 ] and one month [ 12 ] was a negative prognostic sign for seizure freedom. Similar adult cohort studies have used 6-12 months post-operatively to define Engel's outcome [ 25 , 29 ].…”

Electrocorticography-Guided Resection Enhances Postoperative Seizure Freedom in Low-Grade Tumor-Associated Epilepsy: A Systematic Review and Meta-Analysis

“…The titles/abstracts of each were screened against the study inclusion criteria, leading to the identification of 96 records for further screening, of which 7 could not be located. After a full-text review, 31 studies 11,22-51 were included in the present analysis (Table 1). Across studies, a total of 1206 patients with complete follow-up and outcome data were included, of whom 830 (68.82%) underwent ECoG-guided resection.…”