Department of Sperimental and Clinical Medical Science, DISM, University of Udine, Italy; Children's Brain Tumour Research Centre, University of Nottingham, UK.
Children's Brain Tumour Research Centre, University of Nottingham, UK.
Seizure. 2018 May;58:17-21. doi: 10.1016/j.seizure.2018.03.016. Epub 2018 Mar 21.
Epileptic seizures complicate the management of childhood brain tumours. There are no published standards for clinical practice concerning risk factors, treatment selection or strategies to withdraw treatment with antiepileptic drugs (AED).
we undertook a case note review of 120 patients with newly diagnosed brain tumours, referred to a regional paediatric cancer service.
data was available on 117/120 (98%) children <18 years: median age at tumour presentation was 8.1 years (IQR : 3.6-12.7), median follow up was 33 months (IQR 24-56), and 35/117 (29%) experienced seizures. A cortical tumour location was associated with the highest risk of seizures (OR: 7.1; CI 95% 2.9-17.3). At a median follow up of 24 months (IQR: 15-48), 22/35 (63%) with seizures, had a single seizure episode, 15/35 (43%) were seizure free (SF) on AEDs, 13/35 (37%) were SF off AEDs, and 7/35 (20%) experienced continuing epileptic seizures. Overall 34/35 (97%) were treated with AEDs after a seizure, of whom 12/35 (35%) withdrew from AED medication, and although 4/35 (12%) had seizure relapse, all were after further acute events. The median duration of AED before withdrawal was 11 months (IQR 5-14 months), and the median follow up after withdrawal was 15 months (IQR 5-34 months).
Seizures affect about 1/3rd of children and young people presenting with and being treated for brain tumours particularly when the tumour is in the cerebral cortex. The low risk of recurrent seizures after AED treatment justifies consideration of early withdrawal of AED after seizure control.
癫痫发作使儿童脑瘤的治疗复杂化。目前尚无关于风险因素、治疗选择或停止抗癫痫药物（AED）治疗策略的临床实践标准。
我们对 120 名新诊断为脑瘤的患者进行了病历回顾，这些患者被转诊到一个区域性儿科癌症服务机构。
120 名<18 岁儿童中有 117 名（98%）的数据可用：肿瘤表现时的中位年龄为 8.1 岁（IQR：3.6-12.7），中位随访时间为 33 个月（IQR 24-56），35/117（29%）发生癫痫发作。皮质肿瘤部位与癫痫发作的风险最高相关（OR：7.1；95%CI 2.9-17.3）。在中位数为 24 个月（IQR：15-48）的随访中，35 例癫痫发作中有 22 例（63%）仅有一次发作，15/35（43%）在 AED 治疗下无癫痫发作（SF），13/35（37%）在停用 AED 时无癫痫发作，7/35（20%）持续癫痫发作。总体而言，35 例中有 34 例（97%）在癫痫发作后接受了 AED 治疗，其中 12 例（35%）停止了 AED 治疗，尽管 4 例（12%）有癫痫发作复发，但均发生在进一步的急性事件后。开始停药前 AED 的中位持续时间为 11 个月（IQR 5-14 个月），停药后中位随访时间为 15 个月（IQR 5-34 个月）。
癫痫发作影响约 1/3 出现和接受脑瘤治疗的儿童和年轻人，尤其是当肿瘤位于大脑皮层时。在癫痫发作得到控制后，AED 治疗后癫痫复发的风险较低，因此有理由考虑早期停止 AED 治疗。
