Low-grade epilepsy-associated tumors: Epilepsy outcome and antiseizure medication discontinuation after lesionectomies as first-line surgical approach in pediatric population.

Autor: Bernardo P; Department of Neurosciences, Pediatric Psychiatry and Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Scala MR; Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Rubino A; Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Spennato P; Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Mirone G; Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Russo C; Department of Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Santangelo P; Department of Neurosciences, Pediatric Psychiatry and Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Covelli E; Department of Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Grimaldi G; Department of Neurosciences, Pediatric Psychiatry and Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., D'Onofrio V; Department of Pathology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy., Cinalli G; Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy.
Jazyk: angličtina
Zdroj: Epileptic disorders : international epilepsy journal with videotape [Epileptic Disord] 2024 Aug; Vol. 26 (4), pp. 460-470. Date of Electronic Publication: 2024 May 03.
DOI: 10.1002/epd2.20234
Abstrakt: Objective: This study aimed to evaluate epilepsy outcome and antiseizure medication (ASM) discontinuation after lesionectomies as first surgical approach in pediatric population diagnosed with low-grade epilepsy-associated neuroepithelial tumors (LEATs).
Methods: We conducted a retrospective study. Thirty-six consecutive patients with histological diagnoses of LEATs who underwent surgery between 2018 and 2021 at our institution were included. The clinical and surgical data were retrospectively analyzed.
Results: Thirty (83.3%) of 36 patients are free of disabling seizures (Engel class I) and 19 (63,4%) of them are classified as Engel Ia. In 17 (47.2%) patients, ASM could be discontinued. The mean age at surgery was 8.6 years (±4.04) and the mean age at onset of epilepsy was 7.2 years (±3.8), whereas the mean duration of epilepsy in months at the time of surgery was 21.3 months (±23.7). The epileptogenic tumor was in the temporal lobe in 20 (55.5%) patients. Because of seizure persistence, a second or a third surgery was necessary for six patients (16.7%) and four of them had residual lesions (three in temporal and one in extratemporal site). No perioperative complications were recorded, including acute seizures, with a median hospitalization time of 7 days. Shorter epilepsy duration at time of surgery as long as a single ASM was significantly correlated with an Engel class I outcome (p-value = .01 and p-value = .016, respectively). Focal seizure semeiology was associated with an increased probability of antiseizure medication discontinuation (p-value = .042).
Significance: Our findings confirm that shorter epilepsy disease duration, monotherapy before surgery, and seizure semeiology are determinant factors for a positive seizure outcome and medication discontinuation, also with less invasive surgical approaches such as lesionectomies. However, considering the intrinsic multifactorial epileptogenic nature of LEATs, a tailored surgical approach should be considered to optimize clinical and seizure outcome, especially for lesions located in the temporal lobe.
(© 2024 International League Against Epilepsy.)
Databáze: MEDLINE
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