Tsai Min-Lan, Chen Chi-Long, Hsieh Kevin Li-Chun, Miser James S, Chang Hsi, Liu Yen-Lin, Wong Tai-Tong
Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan.
Epilepsy Res. 2018 Nov;147:15-21. doi: 10.1016/j.eplepsyres.2018.08.007. Epub 2018 Aug 23.
Brain tumors are found in 1-3% of children with newly onset of seizures. Understanding the impact of seizures on pediatric brain tumors and factors between seizures and brain tumors are crucial. This study aimed to evaluate the association of pediatric brain tumors on seizure occurrence and the relationships between seizures and the diagnosis and prognosis of brain tumors.
In a cohort of 184 children with newly diagnosed brain tumors between August 2012 and September 2017, 56 patients with brain tumor-associated seizures were evaluated for their clinical characteristics, electroencephalography (EEG), tumor pathology, response to anti-epileptic drugs (AEDs) and their seizure outcome.
The prevalence of seizures in our cohort of children with brain tumors was 30.4% (n = 56/184). Supratentorial tumors were more commonly associated with seizures than were infratentorial tumors (89.3% vs. 10.7%; P < 0.01). Among patients with tumor-associated seizures, the tumors were most commonly located in the temporal lobe (32.1%), followed by the frontal (21.4%) and parietal lobes (16.1%) and other cortices. Thirty-four patients (60.7%) had benign tumor pathology and 22 patients (39.3%) had malignant tumor pathology; low grade astrocytoma (n = 15; 26.8%) was the most common histology type. Seizure onset at initial presentation was more frequently observed in the patients with benign tumors, whereas the patients with malignant tumors tended to have delayed seizure onset (P < 0.01). On EEGs, focal epileptiform discharges were more commonly seen in benign tumors, whereas focal and diffuse slow waves were most commonly associated with malignant tumors. Levetiracetam was the most commonly prescribed AED to treat brain-tumor-associated seizures.
In children with brain tumors, higher seizure frequency with normal neurologic examination was more prevalent in benign tumors, whereas less frequent seizures with focal weakness and signs of increased intracranial pressure were more indicative of malignancy. Delayed onset of seizures was more often observed in the children with malignant brain tumors. Seizure characteristics play an important role in relation to tumor biology and epileptogenesis in pediatric brain tumors.
在初发癫痫的儿童中，脑肿瘤的发病率为1%-3%。了解癫痫对小儿脑肿瘤的影响以及癫痫与脑肿瘤之间的相关因素至关重要。本研究旨在评估小儿脑肿瘤与癫痫发作的相关性，以及癫痫与脑肿瘤诊断和预后的关系。
在2012年8月至2017年9月期间新诊断为脑肿瘤的184例儿童队列中，对56例伴有脑肿瘤相关癫痫的患者进行了临床特征、脑电图（EEG）、肿瘤病理学、抗癫痫药物（AED）反应及其癫痫发作结局的评估。
在我们的脑肿瘤儿童队列中，癫痫发作的患病率为30.4%（n = 56/184）。幕上肿瘤比幕下肿瘤更常与癫痫发作相关（89.3%对10.7%；P < 0.01）。在伴有肿瘤相关癫痫的患者中，肿瘤最常见于颞叶（32.1%），其次是额叶（21.4%）、顶叶（16.1%）和其他皮质。34例患者（60.7%）肿瘤病理为良性，22例患者（39.3%）肿瘤病理为恶性；低级别星形细胞瘤（n = 15；26.8%）是最常见的组织学类型。在良性肿瘤患者中，初次就诊时癫痫发作更为常见，而恶性肿瘤患者的癫痫发作往往延迟（P < 0.01）。在脑电图上，局灶性癫痫样放电在良性肿瘤中更常见，而局灶性和弥漫性慢波最常与恶性肿瘤相关。左乙拉西坦是治疗脑肿瘤相关癫痫最常用的抗癫痫药物。
在患有脑肿瘤的儿童中，神经系统检查正常但癫痫发作频率较高在良性肿瘤中更为普遍，而癫痫发作频率较低且伴有局灶性无力和颅内压升高体征则更提示为恶性肿瘤。恶性脑肿瘤患儿癫痫发作延迟更为常见。癫痫发作特征在小儿脑肿瘤的肿瘤生物学和癫痫发生中起着重要作用。
