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Pre-surgical evaluation challenges and long-term outcome in children operated on for Low Grade Epilepsy Associated brain Tumors

  • Evelyn Karina Chávez López
    Correspondence
    Corresponding author. Street Rosselló 481, 1st Floor, 1st Door, Code Postal 08025, Barcelona, Spain.
    Affiliations
    Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
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  • Javier Aparicio
    Affiliations
    Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
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  • Carlos Valera
    Affiliations
    Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
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  • Jaume Campistol Plana
    Affiliations
    Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
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  • Alia Ramírez Camacho
    Affiliations
    Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
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  • Carmen Fons
    Affiliations
    Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
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  • Alexis Arzimanoglou
    Affiliations
    Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain

    Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
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Published:October 13, 2022DOI:https://doi.org/10.1016/j.ejpn.2022.10.001

      Highlights

      • LEATs are one of the most common causes of epileptic seizures in children.
      • Associated lesions such as Focal Cortical Dysplasia occur in 56.7% of cases in this series.
      • Pre- and post-surgery neuropsychological evaluation shows no deterioration.
      • Depth recordings (SEEG) may be indicated in drug-resistant epilepsy cases.
      • A comprehensive pre-surgical evaluation increases the chances of seizure control.

      Abstract

      Objetive

      Analyze pre-surgical evaluation modalities, surgical failures, long-term results of surgery and neurocognitive outcome in children with Low-grade Epilepsy Associated brain Tumors (LEAT).

      Methods

      Retrospective observational study of 37 children who underwent epilepsy surgery, with a minimum follow-up of 12 months. At time of surgery, pharmaco-sensitivity (Group 1; n = 8) and drug-resistance (Group 2; n = 29), were considered.

      Results

      Age range of seizure onset was 5 months–14 years (mean 5.73years) and age at surgery was 2.2–18.7years (mean 10.7years). Gangliogliomas (35.1%) or DNTs (29.7%), combined or not to a focal cortical dysplasia (FCD), were the most frequent. Extended lesionectomy 16 children (43.2%) were the most frequently used surgical approach in both groups. At one year of follow-up, 36 children (97.2%) were classified as Engel I. Within the age-range studied, duration of epilepsy and time to surgery appeared to have no impact on clinical and neurocognitive outcome in both groups. It is noteworthy, however, that antiseizure medications (ASMs) were withdrawn in 100% of the pharmacosensitive group vs 34.5% of the drug-resistant group (p = 0.002). In children with a pharmaco-sensitive epilepsy, neurocognitive evaluation showed significant improvement in the verbal comprehension index (p = 0.029).

      Conclusions

      Epilepsy-surgery is a safe therapeutic option for LEATs including for children with seizures controlled by ASMs. Presence of associated lesions is not rare. Comprehensive pre-surgical evaluation increases the chances for control of the seizures, the early discontinuation of medications and favours neurocognitive development.

      Keywords

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