Division of Child Neurology, Department of Pediatrics, Montreal, Québec, Canada.
Department of Pathology, Montreal, Québec, Canada.
Pediatr Neurol. 2019 Aug;97:50-55. doi: 10.1016/j.pediatrneurol.2019.03.020. Epub 2019 Mar 28.
Seizures are one of the most common symptoms of pediatric brain tumors. The purpose of this study was to define seizures related to primary central nervous system tumors and to identify risk factors predictive of seizure occurrence and recurrence.
We reviewed the records of children treated from January 1, 2004, to January 1, 2018 and collected data including age, gender, tumor location, histology, extent of initial resection, seizure characteristics, treatment modalities, recurrence, and seizure control. A binomial logistic regression was performed to determine the risk factors of seizure occurrence.
During the observation period, 348 children were diagnosed with a primary brain tumor. The median age at diagnosis was 7.8 years, and the median follow-up interval was 3.9 years. There were 196 boys (56.3%). In our cohort, a total of 70 children (20.1%) experienced seizures. Most of them (64.3%) had cortical tumors. All patients with dysembryoplastic neuroepithelial tumors and 81.8% of patients with glioneuronal tumors presented seizures. Risk factors associated with an increased risk for seizures included cortical location, tumor recurrence, and age at diagnosis. Thirty-nine (86.7%) patients with seizures at diagnosis were seizure free at last follow-up (Engel 1). Significantly more patients (69.6%) with a gross total resection were withdrawn from their antiepileptic drugs when compared with those with subtotal resection (27.3%, P = 0.007).
Our study is the largest cohort in children with tumor-related seizures and brings new insight in terms of seizure risk according to tumor types and evolution following treatment.
癫痫是小儿脑肿瘤最常见的症状之一。本研究旨在定义与原发性中枢神经系统肿瘤相关的癫痫发作，并确定预测癫痫发作发生和复发的危险因素。
我们回顾了 2004 年 1 月 1 日至 2018 年 1 月 1 日期间接受治疗的儿童的记录，并收集了包括年龄、性别、肿瘤位置、组织学、初始切除范围、癫痫发作特征、治疗方式、复发和癫痫发作控制在内的数据。采用二项逻辑回归分析确定癫痫发作发生的危险因素。
在观察期间，348 名儿童被诊断为原发性脑肿瘤。诊断时的中位年龄为 7.8 岁，中位随访间隔为 3.9 年。其中 196 名男孩（56.3%）。在我们的队列中，共有 70 名儿童（20.1%）出现癫痫发作。他们中的大多数（64.3%）患有皮质肿瘤。所有胚胎发育不良性神经上皮肿瘤患者和 81.8%的神经胶质神经元肿瘤患者均出现癫痫发作。与癫痫发作风险增加相关的危险因素包括皮质位置、肿瘤复发和诊断时的年龄。39 名（86.7%）诊断时有癫痫发作的患者在最后一次随访时无癫痫发作（Engel 1）。与次全切除相比，完全切除的患者（69.6%）明显更多地停用抗癫痫药物（27.3%，P=0.007）。
我们的研究是最大的儿童肿瘤相关性癫痫发作队列研究，根据肿瘤类型和治疗后演变，为癫痫发作风险提供了新的见解。
