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[Infantile spasms associated with a brain tumor]
J M Pedespan1, D Fontan, Y Perel
1Service de Pédiatrie B et de Neurochirurgie, Hôpital Pellegrin, Bordeaux.
Insights
Infantile spasms can rarely be linked to brain tumors. This case highlights a child who developed partial seizures and an astrocytoma years after initial infantile spasms.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
Background:
- Infantile spasms (IS) are typically associated with diffuse brain abnormalities.
- Focal cerebral lesions, such as brain tumors, are an uncommon cause of IS.
Observation:
- A 15-month-old girl presented with IS, initially treated successfully with hydrocortisone and valproic acid.
- EEG showed frontal epileptiform discharges post-treatment.
- At age 5, she developed partial seizures, and imaging revealed a right frontal lobe astrocytoma.
Findings:
- The astrocytoma was surgically excised and followed by radiation therapy.
- Post-intervention, the patient showed normal development and no seizure recurrence at 18 months.
- The relationship between the initial IS and the later-diagnosed brain tumor remains unclear.
Implications:
- This case underscores the importance of thorough investigation in atypical IS presentations.
- It suggests that focal brain lesions, including tumors, may present subtly in early childhood.
- Long-term neurodevelopmental and seizure monitoring is crucial for children with a history of IS.
Background:
Infantile spasms are exceptionally associated with a focal cerebral lesion such as a brain tumor.
Case Report:
A 15 month-old girl was treated with hydrocortisone and valproic acid for infantile spasms that had appeared a few days earlier. Her psychomotor development was considered normal and the CT scan was normal. Clinical symptoms disappeared within 10 days and the EEG became normal except for a few epileptiform discharges in the frontal areas. The girl developed partial seizures at the age of 5 years. Imaging techniques showed a brain tumor in the right frontal lobe. Surgical excision was followed by radiation therapy. Analysis of the tumor showed an astrocytoma. The girl is normal 18 months after intervention.
Conclusion:
It is difficult to determine a relationship between the infantile spasms and the brain tumor in this case. The moderately asymmetrical pattern of the EEG after infantile spasms, the fact that these spasms appeared relatively late and the persistence of discharges, lead to repeated specialized investigations.