Perioperative seizure incidence and risk factors in 223 pediatric brain tumor patients without prior seizures

Clinical article

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Object

The incidence of, and risk factors for, perioperative seizures and the need for perioperative antiepileptic drugs (AEDs) in previously seizure-free children with brain tumors remains unclear. The authors have undertaken a review of previously seizure-free pediatric patients with brain tumors undergoing resection to identify the incidence of seizures in the perioperative period, and to characterize risk factors for perioperative seizures in this population.

Methods

A retrospective review was conducted of all patients between 0 and 19 years of age without prior seizures who underwent intracranial tumor resection at the authors' institution between January 2005 and December 2009.

Results

Of the 223 patients undergoing 229 operations, 7.4% experienced at least 1 clinical seizure during the surgical admission. Over half of all tumors were supratentorial. Only 4.4% of patients received prophylactic AEDs. Independent factors associated with perioperative seizures included supratentorial tumor, age < 2 years, and hyponatremia due to syndrome of inappropriate antidiuretic hormone or cerebral salt wasting. Tumor type, lobe affected, operative blood loss, and length of surgery were not independently associated with seizure incidence.

Conclusions

Perioperative seizures in previously seizure-free children undergoing resection of brain tumors are associated with supratentorial tumor location, age < 2 years, and postoperative hyponatremia. Perioperative seizures are not associated with tumor pathology, tumor size, or frontotemporal location. Due to the low incidence of seizures in this series in patients more than 2 years old with normal serum sodium, the authors recommend that pediatric patients with brain tumors not routinely receive perioperative prophylactic AEDs. However, the role for prophylaxis in patients younger than 2 years of age deserves further study.

Abbreviations used in this paper: AAN = American Academy of Neurology; AED = antiepileptic drug; CSW = cerebral salt wasting; EBL = estimated blood loss; SIADH = syndrome of inappropriate antidiuretic hormone.

Article Information

Address correspondence to: Douglas A. Hardesty, M.D., Children's Hospital of Philadelphia, Wood Center, 6th Floor, 34th and Civic Center Boulevard, Philadelphia, Pennsylvania 19104-4399. email: dharde@mail.med.upenn.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Histogram of patient age, in years, as a percentage of all patients with (upper) or without (lower) perioperative seizures.

References

1

Abend NSHuh JWHelfaer MADlugos DJ: Anticonvulsant medications in the pediatric emergency room and intensive care unit. Pediatr Emerg Care 24:7057212008

2

Bauchet LRigau VMathieu-Daudé HFabbro-Peray PPalenzuela GFigarella-Branger D: Clinical epidemiology for childhood primary central nervous system tumors. J Neurooncol 92:87982009

3

Bussmann CBast TRating D: Hyponatraemia in children with acute CNS disease: SIADH or cerebral salt wasting?. Childs Nerv Syst 17:58632001

4

Cross JH: Neurodevelopmental effects of anti-epileptic drugs. Epilepsy Res 88:1102010

5

De Santis AVillani RSinisi MStocchetti NPerucca E: Add-on phenytoin fails to prevent early seizures after surgery for supratentorial brain tumors: a randomized controlled study. Epilepsia 43:1751822002

6

Farrar HCChande VTFitzpatrick DFShema SJ: Hyponatremia as the cause of seizures in infants: a retrospective analysis of incidence, severity, and clinical predictors. Ann Emerg Med 26:42481995

7

Gaggero RConsales AFazzini FMancardi MMBaglietto MGNozza P: Epilepsy associated with supratentorial brain tumors under 3 years of life. Epilepsy Res 87:1841892009

8

Glantz MJCole BFForsyth PARecht LDWen PYChamberlain MC: Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Neurology 54:188618932000

9

Holmes GL: Epilepsy in the developing brain: lessons from the laboratory and clinic. Epilepsia 38:12301997

10

Khan RBBoop FAOnar ASanford RA: Seizures in children with low-grade tumors: outcome after tumor resection and risk factors for uncontrolled seizures. J Neurosurg 104:6 Suppl3773822006

11

Khan RBHunt DLBoop FASanford RAMerchant TEGajjar A: Seizures in children with primary brain tumors: incidence and long-term outcome. Epilepsy Res 64:85912005

12

Kirmani BFCrisp EDKayani SRajab H: Role of intravenous levetiracetam in acute seizure management of children. Pediatr Neurol 41:37392009

13

Kombogiorgas DJatavallabhula NSSgouros SJosan VWalsh ARHockley AD: Risk factors for developing epilepsy after craniotomy in children. Childs Nerv Syst 22:144114452006

14

Li JXiao NChen S: Efficacy and tolerability of levetiracetam in children with epilepsy. Brain Dev 33:1451512011

15

Lwu SHamilton MGForsyth PACairncross JGParney IF: Use of peri-operative anti-epileptic drugs in patients with newly diagnosed high grade malignant glioma: a single center experience. J Neurooncol 96:4034082010

16

Ng YTHastriter EVCardenas JFKhoury EMChapman KE: Intravenous levetiracetam in children with seizures: a prospective safety study. J Child Neurol 25:5515552010

17

North JBPenhall RKHanieh AFrewin DBTaylor WB: Phenytoin and postoperative epilepsy. A double-blind study. J Neurosurg 58:6726771983

18

Partap SFisher PG: Levetiracetam for seizures in children with brain tumors and other cancers. Pediatr Blood Cancer 52:2882892009

19

Reiter PDHuff ADKnupp KGValuck RJ: Intravenous levetiracetam in the management of acute seizures in children. Pediatr Neurol 43:1171212010

20

Rickert CHPaulus W: Epidemiology of central nervous system tumors in childhood and adolescence based on the new WHO classification. Childs Nerv Syst 17:5035112001

21

Ruggiero ARizzo DMastrangelo SBattaglia DAttinà GRiccardi R: Interactions between antiepileptic and chemotherapeutic drugs in children with brain tumors: is it time to change treatment?. Pediatr Blood Cancer 54:1931982010

22

Rzany BCorreia OKelly JPNaldi LAuquier AStern R: Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a casecontrol study. Lancet 353:219021941999

23

Shuper AYaniv IMichowitz SKornreich LSchwartz MGoldberg-Stern H: Epilepsy associated with pediatric brain tumors: the neuro-oncologic perspective. Pediatr Neurol 29:2322352003

24

Sogawa YKan LLevy ASMaytal JShinnar S: The use of antiepileptic drugs in pediatric brain tumor patients. Pediatr Neurol 41:1921942009

25

Temkin NR: Prophylactic anticonvulsants after neurosurgery. Epilepsy Curr 2:1051072002

26

Temkin NRDikmen SSWilensky AJKeihm JChabal SWinn HR: A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 323:4975021990

27

van Breemen MSWilms EBVecht CJ: Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6:4214302007

28

Vecht CJWagner GLWilms EB: Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2:4044092003

29

Wilne SCollier JKennedy CKoller KGrundy RWalker D: Presentation of childhood CNS tumours: a systematic review and meta-analysis. Lancet Oncol 8:6856952007

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