Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Department of Hematology/Oncology and Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Epilepsia. 2015 Oct;56(10):1599-604. doi: 10.1111/epi.13112. Epub 2015 Aug 31.
Seizures are common during and after treatment for a primary brain tumor. Our objective was to describe the incidence and risk factors for seizures in long-term survivors of pediatric brain tumors.
In a retrospective, longitudinal study, we reviewed all consecutive patients during a 12-month period who were at least 2 years post initial diagnosis of a brain tumor. Data collection included age at diagnosis, length of follow-up, extent of initial resection, tumor histology, and treatment modalities. For patients who had experienced seizures at any time, the timing and frequency of seizures, seizure semiology, electroencephalography results, and anticonvulsant use were recorded. Univariate analyses and logistic regression were performed to assess risk factors.
The cohort included 298 patients (140 female). Average duration of follow-up was 7.6 years. Initial surgical resection was gross-total in 109 patients, and subtotal for 143. Twenty-nine patients underwent biopsy alone and 17 had no surgical intervention. Tumor location included posterior fossa (104; 36%), midline (98; 34%), cortical (85; 29%), and other (11; 3%). Most frequent diagnoses were low grade glioma, medulloblastoma, and ependymoma. Other treatments included cranial irradiation (N = 163) and chemotherapy (n = 127). Tumor recurrence occurred in 92 patients (30%). Seventy-one patients had seizures (24%). Ongoing seizures at the time of most recent follow-up were present in 42 patients. Risk factors for seizures included tumor location, tumor histology, tumor recurrence, and incomplete resection at time of initial presentation.
Seizures are a frequent comorbidity in pediatric brain tumor survivors, seen at presentation in 24% of patients and ongoing in 14%. Factors predisposing to seizures include tumor pathology (low/high grade glioma, glioneuronal tumor), cortical location, and subtotal resection. These data may assist in identification and management of patients at highest risk for seizures as well as identification of patients for potential treatment trials with antiepileptogenic agents.
原发性脑肿瘤在治疗期间和之后常发生癫痫。我们的目的是描述儿童脑肿瘤长期幸存者癫痫的发生率和危险因素。
在一项回顾性纵向研究中，我们对初始诊断为脑肿瘤后至少 2 年的 12 个月期间的所有连续患者进行了回顾。数据收集包括诊断时的年龄、随访时间、初始切除范围、肿瘤组织学和治疗方式。对于任何时候有过癫痫发作的患者，记录发作的时间和频率、发作的表现、脑电图结果和抗癫痫药物的使用情况。进行单变量分析和逻辑回归分析以评估危险因素。
队列包括 298 名患者（140 名女性）。平均随访时间为 7.6 年。109 例患者初始手术切除为大体全切除，143 例患者为次全切除。29 例患者仅行活检，17 例患者未行手术干预。肿瘤部位包括后颅窝（104 例，36%）、中线（98 例，34%）、皮质（85 例，29%）和其他部位（11 例，3%）。最常见的诊断是低级别胶质瘤、髓母细胞瘤和室管膜瘤。其他治疗方法包括颅放疗（163 例）和化疗（127 例）。92 例患者发生肿瘤复发。71 例患者发生癫痫（24%）。在最近一次随访时仍有持续性癫痫发作的患者有 42 例。癫痫的危险因素包括肿瘤位置、肿瘤组织学、肿瘤复发和初始表现时的不完全切除。
癫痫是儿童脑肿瘤幸存者的常见合并症，24%的患者在就诊时出现癫痫，14%的患者持续存在癫痫。易患癫痫的因素包括肿瘤病理学（低级别/高级别胶质瘤、神经胶质细胞瘤）、皮质位置和次全切除。这些数据可能有助于识别和管理癫痫风险最高的患者，以及识别潜在的抗癫痫药物治疗试验的患者。
