Epilepsy associated with supratentorial brain tumors under 3 years of life.
OBJECTIVE
To investigate the clinical features and outcome of epilepsy in children under 3 years of age with supratentorial brain tumors.


METHODS
Patients under 3 years with primary supratentorial hemispheric brain tumors were collected during a 10-year period through a database including demographic and clinical features, neuroimaging, tumor location, developmental outcome, pharmacological and surgical treatment, and tumor histology. Postoperative outcome was assessed according to Engel classification.


RESULTS
Among 28 children evaluated, twenty (71.4%) suffered from epilepsy. Mean age at seizure onset was 18.7 months (range: 1-60). In fifteen (75%) children, epilepsy was an early manifestation or the presenting symptom of the tumor; seizures were focal in 8 (53.3%) and generalized in 7 (46.7%) individuals. Three (15%) children presented with an epileptic encephalopathy and continuous spike-waves during sleep. Of the five children with epilepsy onset after surgery, four had focal seizures. Post-surgical follow-up ranged from 4 to 10 years (mean: 7.6+/-3.74). The outcome of epilepsy was generally good, with most children (76.4%) being seizure free (Engel I) or showing >90% improvement in seizure frequency (Engel II) after surgery. However, in about 20% of the cases, epilepsy persisted despite surgery and different AEDs regimen. Best epilepsy outcome was observed in patients with low-grade tumors (p<0.01) and without neurological deficits after surgery (p<0.001).


CONCLUSIONS
Epilepsy is a common and early symptom in infants with brain tumors. Its outcome is negatively influenced by high tumor malignancy and by the persistence of neurological deficits after surgery. Treatment of these patients needs a multidisciplinary approach.
Department of Neurosciences, Gaslini Children's Hospital, Genoa, Italy. garob@iol.it
Roberto
R
Gaggero
Alessandro
A
Consales
Francesca
F
Fazzini
Maria Margherita
MM
Mancardi
Maria Giuseppina
MG
Baglietto
Paolo
P
Nozza
Andrea
A
Rossi
Angela
A
Pistorio
Miriam
M
Tumolo
Armando
A
Cama
Maria Luisa
ML
Garrè
Pasquale
P
Striano
D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000601:surgery; D002277:Carcinoma / Q000150:complications / Q000628:therapy; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D016208:Databases, Factual; D018572:Disease-Free Survival; D004828:Epilepsies, Partial / Q000209:etiology* / Q000628:therapy; D004829:Epilepsy, Generalized / Q000209:etiology* / Q000628:therapy; D005260:Female; D005910:Glioma / Q000150:complications* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009364:Neoplasm Recurrence, Local; D018242:Neuroectodermal Tumors, Primitive / Q000150:complications / Q000628:therapy; D011184:Postoperative Period; D015173:Supratentorial Neoplasms / Q000150:complications* / Q000628:therapy; D013724:Teratoma / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D000927:Anticonvulsants; D014750:Vincristine; D003520:Cyclophosphamide; D002945:Cisplatin