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Brain tumors presenting as a seizure disorder in infants
Insights
Supratentorial tumors are rare causes of seizures in infants under one year old. Early diagnosis and aggressive neurosurgical intervention are crucial for positive outcomes in these young patients.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Pediatric Neurosurgery
Background:
- Seizures are common in children with supratentorial tumors, presenting in 25-40% of cases.
- Infants under one year old represent only 2% of seizure presentations for brain tumors.
- This study focuses on three infants under one year with seizures as the primary symptom of supratentorial tumors.
Observation:
- Three infants (20 days to 7 months) presented with intractable or focal seizures.
- Computed tomographic (CT) scans revealed contrast-enhancing medial temporal lobe masses in all patients.
- Electroencephalography (EEG) indicated focal abnormalities in two patients, prompting CT scans.
Findings:
- All three patients underwent surgical resection of temporal lobe tumors.
- Histopathology confirmed diverse tumor types: ganglioglioma, fibrillary astrocytoma, and anaplastic astrocytoma.
- All children achieved complete seizure freedom postoperatively.
Implications:
- Supratentorial tumors should be considered in the differential diagnosis of seizures in infants under one year.
- Prompt neurosurgical evaluation and intervention are recommended for suspected pediatric brain tumors presenting with seizures.
- Advances in CT scanning have increased the recognition of supratentorial tumors in this young age group.
Abstract:
Seizures occur in 25% to 40% of children with supratentorial tumors and are the presenting complaint in 10% to 15%. However, when divided by age, only 2% of children with seizures as the presenting complaint of brain tumors were less than 1 year of age. Three children, ranging in age from 20 days to 7 months and seen within the past 2 years, form the basis of this report. The presenting complaint in all children was seizures. Computed tomographic (CT) scan was indicated in all children because of intractability to anticonvulsant drug therapy (one patient) and focal electroencephalographic (EEG) abnormality with clinical evidence of complex partial seizure activity (two patients). CT scan showed a contrast-enhancing mass in the medial temporal lobe in all patients. At surgery, a temporal lobe tumor was found and resected in all children. Histopathologic examination revealed a ganglioglioma, a fibrillary astrocytoma, and an anaplastic astrocytoma. All children did well postoperatively and are seizure free to date. Our experience suggests that supratentorial tumors should be considered as a cause of intractable and/or focal seizures in children under 1 year of age, and that such tumors should be attacked aggressively neurosurgically. Our experience is also in agreement with that of Tadmor et al, who have suggested that with the advent of CT scanning supratentorial tumors in this age group have been found to be more common than previously realized.