Department of Neurosciences, Gaslini Children's Hospital, Genoa, Italy.
Epilepsy Res. 2009 Dec;87(2-3):184-9. doi: 10.1016/j.eplepsyres.2009.08.012. Epub 2009 Sep 23.
To investigate the clinical features and outcome of epilepsy in children under 3 years of age with supratentorial brain tumors.
Patients under 3 years with primary supratentorial hemispheric brain tumors were collected during a 10-year period through a database including demographic and clinical features, neuroimaging, tumor location, developmental outcome, pharmacological and surgical treatment, and tumor histology. Postoperative outcome was assessed according to Engel classification.
Among 28 children evaluated, twenty (71.4%) suffered from epilepsy. Mean age at seizure onset was 18.7 months (range: 1-60). In fifteen (75%) children, epilepsy was an early manifestation or the presenting symptom of the tumor; seizures were focal in 8 (53.3%) and generalized in 7 (46.7%) individuals. Three (15%) children presented with an epileptic encephalopathy and continuous spike-waves during sleep. Of the five children with epilepsy onset after surgery, four had focal seizures. Post-surgical follow-up ranged from 4 to 10 years (mean: 7.6+/-3.74). The outcome of epilepsy was generally good, with most children (76.4%) being seizure free (Engel I) or showing >90% improvement in seizure frequency (Engel II) after surgery. However, in about 20% of the cases, epilepsy persisted despite surgery and different AEDs regimen. Best epilepsy outcome was observed in patients with low-grade tumors (p<0.01) and without neurological deficits after surgery (p<0.001).
Epilepsy is a common and early symptom in infants with brain tumors. Its outcome is negatively influenced by high tumor malignancy and by the persistence of neurological deficits after surgery. Treatment of these patients needs a multidisciplinary approach.
研究幕上脑肿瘤 3 岁以下儿童癫痫的临床特征和预后。
通过包括人口统计学和临床特征、神经影像学、肿瘤位置、发育结局、药物和手术治疗以及肿瘤组织学等数据库，收集了 10 年间 3 岁以下原发性幕上大脑半球肿瘤患儿的资料。根据 Engel 分类评估术后结局。
在评估的 28 例患儿中，有 20 例（71.4%）患有癫痫。癫痫发作的平均年龄为 18.7 个月（范围：1-60 个月）。在 15 例（75%）患儿中，癫痫是肿瘤的早期表现或首发症状；8 例（53.3%）为局灶性发作，7 例（46.7%）为全面性发作。3 例（15%）患儿表现为癫痫性脑病和睡眠中持续棘慢波。在术后癫痫发作的 5 例患儿中，有 4 例为局灶性发作。术后随访时间为 4-10 年（平均 7.6+/-3.74 年）。癫痫的预后一般较好，大多数患儿（76.4%）术后无癫痫发作（Engel I）或癫痫发作频率改善>90%（Engel II）。然而，约 20%的病例尽管手术和不同的 AED 治疗方案仍持续存在癫痫。低级别肿瘤患儿（p<0.01）和术后无神经功能缺损的患儿（p<0.001）癫痫预后最佳。
癫痫是脑肿瘤婴儿的常见和早期症状。其预后受肿瘤恶性程度高和术后神经功能缺损持续存在的负面影响。这些患者的治疗需要多学科方法。
