Seizure outcomes following epilepsy surgery in pediatric and young adult patients with high-grade brain tumors: Results from a European survey

Abstract

Objective: Epilepsy surgery is a standard treatment for drug-resistant epilepsy, resulting in seizure freedom in a significant number of cases. Although frequently performed for low-grade brain tumors, it is rarely considered for high-grade tumors, despite the impact of chronic epilepsy on quality of life and cognition.

Methods: This retrospective multicenter study across 43 European centers evaluated epilepsy surgery outcomes in children with high-grade brain tumors (World Health Organization grades III and IV). Two cohorts of patients younger than 25 years were studied: (1) those undergoing epilepsy surgery after tumor resection (n = 14) and (2) those initially suspected of low-grade lesions but diagnosed with high-grade brain tumors postsurgery (n = 11).

Results: Eighty percent of patients achieved seizure freedom 1 year after last epilepsy surgery: 71% in Cohort 1 and 91% in Cohort 2. Eighty-four percent were free of disabling seizures (Engel IA-D) after a median follow-up period of 4.3 years (range = 1-15.9 years). No surgery-related deaths occurred. Thirty-two percent of children experienced persistent morbidity, including motor dysfunction, visual impairment, persistent seizures, cognitive deficits, and hydrocephalus.

Significance: Epilepsy surgery is effective for medically refractory epilepsy in children with high-grade central nervous system tumors and should be considered early, as seizure freedom is achieved in the majority of patients. Despite involving numerous epilepsy centers, only 25 patients were recruited, indicating that this method is rarely considered for high-grade brain tumor patients with medically refractory epilepsy.

Keywords: children; drug‐resistant epilepsy; epilepsy surgery; high‐grade brain tumors; seizure freedom.

FIGURE 1

Enrollment criteria for both cohorts. ASM, antiseizure medication; w/wo, with/without; WHO, World Health Organization.

FIGURE 2

(A) Presurgical seizure frequency, tumor histology, and surgical procedure. (B) Postsurgical seizure outcome. (A) Bar graphs illustrating presurgical seizure frequency, tumor histology and the type of epilepsy surgery performed (last surgery). ATRT, atypical teratoid/rhabdoid tumor; DGONC, diffuse glioneuronal tumor with oligodendrogliomalike features and nuclear clusters; DNET, dysembryoplastic neuroepithelial tumor; ETMR, embryonal tumor with multilayered rosettes; PNET, primitive neuroectodermal tumor. Anaplastic glioma includes anaplastic astrocytoma, anaplastic oligodendroglioma, and anaplastic oligoastrocytoma. (B) Bar graphs depicting postsurgical seizure freedom 1 year after the last epilepsy surgery (if multiple surgeries were performed) and surgical outcomes according to the Engel classification.