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

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  • 1 Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical Center, Tel Aviv University;
  • 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
  • 3 Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
  • 4 Department of Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas;
  • 5 Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany; and
  • 6 Pediatric Neurology Unit, Dana Children’s Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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OBJECTIVE

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.

METHODS

Data were collected retrospectively from 4 large tertiary centers for children (< 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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS AED = antiepileptic drug; ECoG = electrocorticography; GTR = gross-total resection; LGG = low-grade glioma; STET = supratentorial extratemporal.

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Contributor Notes

Correspondence Jonathan Roth: Dana Children’s Hospital, Tel Aviv Medical Center, Tel Aviv, Israel. jonaroth@gmail.com.

INCLUDE WHEN CITING Published online April 3, 2020; DOI: 10.3171/2020.2.PEDS19673.

J.R. and O.B. contributed equally to this study.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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