Extra-temporal pediatric low-grade gliomas and epilepsy

Area of Science:

• Pediatric neuro-oncology
• Epileptology
• Neurosurgery

Background:

• Low-grade gliomas (LGGs), particularly glioneuronal tumors, are a primary cause of medically refractory epilepsy in children.
• Seizure control significantly impacts pediatric patients' quality of life, often more than the tumor itself.
• The mechanisms underlying tumor-related seizures in focal LGGs are complex and likely vary by patient and tumor type.

Purpose of the Study:

• To review the current understanding of pediatric low-grade gliomas associated with epilepsy.
• To discuss diagnostic and therapeutic strategies, emphasizing surgical resection and emerging treatments.
• To highlight the importance of epilepsy resolution in the overall management of pediatric LGGs.

Main Methods:

• Review of literature on pediatric low-grade gliomas and epilepsy.
• Analysis of tumor types, including astrocytic gliomas and glioneuronal tumors (e.g., gangliogliomas, DNETs).
• Discussion of treatment modalities, focusing on surgical resection and its predictive value for seizure control.

Main Results:

• Complete surgical resection is the primary predictor of successful postoperative seizure control in pediatric LGGs.
• Long-term epilepsy-associated tumors (LEATs) are often well-circumscribed, facilitating complete resection and epilepsy management.
• Emerging treatments like laser ablation and BRAF inhibitors offer alternatives to traditional surgery.

Conclusions:

• Epilepsy resolution is a critical treatment goal for pediatric low-grade gliomas.
• Surgical management, aiming for complete resection, remains central to achieving seizure control.
• Future research into seizure biomarkers and molecular pathways promises more targeted and effective treatment strategies.