Frontoparietal astrocytoma causing absence seizures and bilaterally synchronous epileptiform discharges

We describe an 8-year-old child who had had seizures since age 2. Initially, the seizures involved staring and turning the head to the left. Later, his seizures were brief, frequent staring spells. At age 8, an occasional seizure occurred involving back arching, eyelid fluttering, lip smacking, and pulling at clothing. Also at age 8, the seizures became refractory to phenobarbital, phenytoin, ethosuximide, and carbamazepine. Electroencephalogram showed fairly frequent bilaterally synchronous spike- slow-wave discharges. Computerized tomography showed a hypodense lesion in the right frontoparietal region, with a small contrast-enhancing nodule on one side. The lesion was resected at craniotomy and found to be a cystic Grade I astrocytoma. The patient has been seizure-free for the 2 years that have elapsed since the tumor was removed, the last 18 months without anticonvulsants. His EEG is normal. We conclude that the tumor caused his EEG findings and his long-standing absence seizure disorder.