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Seizures in children with supratentorial astroglial neoplasms
J A Shady1, P M Black, W J Kupsky
1Department of Neurosurgery, Children's Hospital Medical Center, Harvard Medical School, Boston, MA 02115.
Insights
Seizures are a common presenting symptom in pediatric supratentorial astroglial neoplasms, particularly in cortical tumors like gangliogliomas and oligoastrocytomas. Presenting seizures correlate with a good prognosis in these young patients.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Epileptology
Background:
- Supratentorial astroglial neoplasms are a significant cause of neurological morbidity in children.
- Seizures are a frequent clinical manifestation in pediatric brain tumors, but their specific role in astroglial neoplasms requires further elucidation.
Purpose of the Study:
- To investigate the incidence and characteristics of seizures in children with supratentorial astroglial neoplasms.
- To determine the correlation between seizure presentation and tumor location, histology, and patient prognosis.
Main Methods:
- Retrospective review of 98 pediatric patients (≤18 years) with pathologically confirmed supratentorial astroglial neoplasms.
- Analysis of presenting symptoms, seizure types, electroencephalography (EEG) findings, tumor histology (WHO criteria), and patient outcomes.
- Statistical correlation of seizure presentation with tumor characteristics and prognosis.
Main Results:
- Fifty percent of patients presented with seizures, and 30% had seizures as their sole presenting symptom.
- Complex or simple partial seizures were most common (77%). Cortical tumors (59%) and specific types (gangliogliomas 88%, oligoastrocytomas 86%) showed higher seizure incidence.
- Preoperative EEG accurately lateralized the tumor in 88% of cases. Seizures at presentation were significantly associated with a good prognosis (p=0.02).
Conclusions:
- Seizures are a critical presenting feature in pediatric supratentorial astroglial neoplasms, especially cortical and specific tumor subtypes.
- EEG is a valuable tool for tumor localization in these patients.
- The presence of seizures at presentation is a favorable prognostic indicator in pediatric astroglial neoplasms.
Abstract:
We reviewed the records of 98 consecutive patients, 18 years of age or younger, with pathologically confirmed supratentorial astroglial neoplasms at the Children's Hospital, Boston, to evaluate the importance of seizures in their presentation and natural history. Tumors were diagnosed using the WHO criteria as pilocytic astrocytomas, astrocytomas, anaplastic astrocytomas, glioblastomas, giant cell glioblastomas, oligoastrocytomas and gangliogliomas. Our results were as follows. (1) Fifty percent of children had seizures as part of their presentation and 30% had seizures as their only presenting phenomenon. (2) The seizures varied in nature, but complex (55%) or simple (28%) partial seizures were by far the most common types, occurring in 77% of cases. (3) Preoperative electroencephalography (EEG) accurately lateralized to the tumor side in 88% of the cases and localized to the correct lobe in 56%. (4) Tumors involving cerebral cortex significantly correlated with seizures at presentation as compared to noncortical locations; 59% of patients with cortical tumors presented with seizures, and only 15% of patients with noncortical tumors experienced seizures. Lesions in the temporal and frontal lobes had the highest incidence of seizures. (5) Patients with gangliogliomas and oligoastrocytomas had the highest incidence of seizures, 88 and 86%, respectively, whereas patients with anaplastic astrocytoma had the lowest incidence, 21%. (6) Histopathologic calcification was associated with seizures at presentation approaching significance (p = 0.06). (7) Seizures at presentation were significantly associated with good prognosis (p = 0.02).