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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Predictors of Seizure Outcome After Epilepsy Surgery in Pediatric Patients With Low-Grade Developmental and
Florian Mayer1, Matthias Tomschik2, Johannes Zielke1
1Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Member of ERN EpiCARE, Vienna, Austria.
Insights
Complete tumor resection is crucial for seizure freedom in children with low-grade developmental and epilepsy-associated brain tumors (LEATs). However, early evaluation is vital as the seizure zone may extend beyond the tumor itself.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Low-grade developmental and epilepsy-associated brain tumors (LEATs) frequently cause drug-resistant focal epilepsies in children.
- While epilepsy surgery offers positive outcomes for many, 20-30% of patients remain seizure-free post-operation.
Purpose of the Study:
- To identify predictors of postoperative outcomes and seizure recurrence in pediatric patients with LEATs.
- To analyze factors influencing spontaneous or antiseizure medication (ASM) tapering-related seizure recurrence.
Main Methods:
- Retrospective cohort study of pediatric patients with LEAT-associated epilepsy.
- Analysis of clinical and demographic parameters impacting seizure recurrence after surgery.
- Data collected from the Medical University of Vienna pediatric epilepsy center (1993-2023).
Main Results:
- 74.4% of 82 patients achieved seizure freedom; 80% successfully discontinued ASMs.
- Incomplete tumor resection was the strongest predictor of unfavorable outcomes (OR 53.5, P < 0.001).
- Notably, 33% of patients with unfavorable outcomes had complete resections, often with longer epilepsy duration (84.1 vs 12.9 months, P=0.02).
Conclusions:
- Complete tumor resection is essential for managing LEATs-associated epilepsy.
- In cases of prolonged epilepsy, the epileptogenic zone may extend beyond the lesion, necessitating comprehensive preoperative evaluation.
- Early and thorough preoperative assessment is critical for optimizing surgical outcomes and achieving seizure freedom.
Background:
Low-grade developmental and epilepsy-associated brain tumors (LEATs) are common causes of childhood-onset drug-resistant focal epilepsies. Although epilepsy surgery shows favorable outcomes in most patients, approximately 20%-30% of them do not become seizure free. This study aimed to identify predictors of postoperative outcomes and seizure recurrence, either spontaneously or after antiseizure medication (ASM) tapering, in a pediatric cohort with LEATs.
Methods:
This retrospective cohort study included pediatric patients with LEAT-associated epilepsy who underwent preoperative evaluation and epilepsy surgery at the Medical University of Vienna pediatric epilepsy center from 1993 through 2023. We analyzed the impact of clinical and demographic parameters on spontaneous- or ASM-reduction-related seizure recurrence.
Results:
In total, 82 patients were included. The median age at surgery was 10.2 years (interquartile range [IQR], 5.3-14.0) and the median follow-up was 60 months (IQR, 36-120); 74.4% of patients became seizure free. ASM discontinuation was successful in 80% of cases. Despite incomplete resections being the strongest predictor of unfavorable outcomes at final follow-up (odds ratio, 53.5; 95% confidence interval = 8.5-337.1; P < 0.001), 33% of patients with unfavorable outcomes had undergone complete resections. These patients had a significantly longer epilepsy duration before surgery than those with incomplete resections and unfavorable outcomes (84.1 vs 12.9 months; P = 0.02).
Conclusions:
Complete tumor resection is essential in patients with LEATs. However, especially in patients with longer epilepsy duration, the epileptogenic zone may exceed the epileptogenic lesion, and exclusive resection of the tumor may therefore not be sufficient to achieve seizure freedom. This fact underscores the importance of early preoperative evaluation.
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