Current management of low-grade, epilepsy-associated brain tumors in Europe

Low-grade epilepsy-associated brain tumors (LEATs) are a frequent cause of drug-resistant focal epilepsy in both children and adults. Epilepsy surgery is a well-recognized treatment option, with almost 80% of patients being seizure-free at 1 year, and 50% of children being seizure- and drug-free at 5 years. Despite these outcomes, standardized management guidelines remain lacking. The present study aimed to assess current practices in Europe. A comprehensive web-based survey was conducted by EpiCARE (European Reference Network for Rare and Complex Epilepsies). Responses were collected from 172 clinicians representing 75 institutions in 26 European region countries. The questionnaire addressed institutional protocols, individual practices, referral pathways, presurgical evaluation, histopathology, molecular diagnostics, and follow-up. Clinicians largely agreed that epileptic seizures are a major comorbidity in LEAT patients, and most reported that seizure frequency and duration influence their treatment approach. This reflects an understanding of LEATs not only as an oncological entity, but above all as an epileptogenic lesion with a strong impact on quality of life, systematically requiring a multidisciplinary approach. Significant inconsistencies were identified, particularly regarding referral pathways, presurgical assessment (66% referred systematically to an epilepsy team), and molecular diagnostics. Only 48% of respondents reported having institutional protocols in place. Although the majority supported early referral to an epilepsy surgery team after diagnosis (even in the absence of confirmed drug resistance), 13% still required failure of at least two antiseizure medications. Long-term postsurgical follow-up was recommended by 89% of clinicians beyond 1 year after surgery. Almost all clinicians acknowledged that histopathology influenced clinical decision-making for follow-up, and 87.2% were familiar with the World Health Organization 2021 central nervous system tumor classification and molecular diagnostics. This large European study shows growing alignment with international recommendations, but significant inconsistencies remain in clinical practice, particularly regarding referral pathways, presurgical assessment, and molecular diagnostics. These findings highlight the need for consensus-driven international guidelines for LEAT management.