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Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas

Objective: Pediatric low-grade gliomas (LGGs) are found in approximately one to three percent of patients with childhood epilepsy. Epilepsy in these patients is often medically refractory and therefore represents a unique cohort with significant morbidity from concomitant pathology. Similar studies...

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Autores principales: Budnick, Hailey C, Baygani, Shawyon, Easwaran, Teresa, Vortmeyer, Alexander, Jea, Andrew, Desai, Virendra, Raskin, Jeffrey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792195/
https://www.ncbi.nlm.nih.gov/pubmed/36579273
http://dx.doi.org/10.7759/cureus.31915
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author Budnick, Hailey C
Baygani, Shawyon
Easwaran, Teresa
Vortmeyer, Alexander
Jea, Andrew
Desai, Virendra
Raskin, Jeffrey
author_facet Budnick, Hailey C
Baygani, Shawyon
Easwaran, Teresa
Vortmeyer, Alexander
Jea, Andrew
Desai, Virendra
Raskin, Jeffrey
author_sort Budnick, Hailey C
collection PubMed
description Objective: Pediatric low-grade gliomas (LGGs) are found in approximately one to three percent of patients with childhood epilepsy. Epilepsy in these patients is often medically refractory and therefore represents a unique cohort with significant morbidity from concomitant pathology. Similar studies in adult patients with low-grade gliomas have identified predictors of seizure freedom including gross-total resection, preoperative seizure control on antiepileptic medication and duration of seizures of less than one year. This study aims to identify similar predictors of seizure freedom in operatively managed pediatric LGGs. Methods: A retrospective chart review was performed for patients diagnosed with World Health Organization (WHO) Grade I and II gliomas in patients ≤18 years old at a single institution (Indiana University School of Medicine at Riley Hospital for Children in Indianapolis, IN) from 2007-2017. Infratentorial and purely intraventricular lesions were excluded. WHO classification and histologic diagnosis were based on surgical pathology. Tumor grade, location, laterality, seizure status at presentation, and AED requirements pre- and post-operatively were recorded. Chi-squared analyses for independence were performed controlling for age at presentation, resection extent, seizure type, and Engel Class for seizure freedom post-operatively. Results: Forty-two patients met the inclusion criteria. Preoperative seizures were observed in 23 patients (55%). Presentation with preoperative seizures was highly associated with continued seizure burden post-operatively, independent of the extent of surgical resection. Supratentorial location and the administration of prophylactic pre- and post-operative AEDs were associated with Engel Class I seizure freedom. Temporal location was not significantly associated with medically refractory epilepsy compared with extra-temporal locations. Conclusions: In our cohort of pediatric LGGs, we find that patients that did not initially present with seizures and those who were treated with prophylactic pre- and post-operative AEDs, were more likely to achieve Engel Class I seizure freedom post-operatively. Tumors located in the temporal location were not significantly associated with a higher seizure burden than other supratentorial, extra-temporal tumors. Neither extent of resection nor electrocorticography-guided resection correlated with improved seizure freedom outcomes during glioma resection.
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spelling pubmed-97921952022-12-27 Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas Budnick, Hailey C Baygani, Shawyon Easwaran, Teresa Vortmeyer, Alexander Jea, Andrew Desai, Virendra Raskin, Jeffrey Cureus Neurology Objective: Pediatric low-grade gliomas (LGGs) are found in approximately one to three percent of patients with childhood epilepsy. Epilepsy in these patients is often medically refractory and therefore represents a unique cohort with significant morbidity from concomitant pathology. Similar studies in adult patients with low-grade gliomas have identified predictors of seizure freedom including gross-total resection, preoperative seizure control on antiepileptic medication and duration of seizures of less than one year. This study aims to identify similar predictors of seizure freedom in operatively managed pediatric LGGs. Methods: A retrospective chart review was performed for patients diagnosed with World Health Organization (WHO) Grade I and II gliomas in patients ≤18 years old at a single institution (Indiana University School of Medicine at Riley Hospital for Children in Indianapolis, IN) from 2007-2017. Infratentorial and purely intraventricular lesions were excluded. WHO classification and histologic diagnosis were based on surgical pathology. Tumor grade, location, laterality, seizure status at presentation, and AED requirements pre- and post-operatively were recorded. Chi-squared analyses for independence were performed controlling for age at presentation, resection extent, seizure type, and Engel Class for seizure freedom post-operatively. Results: Forty-two patients met the inclusion criteria. Preoperative seizures were observed in 23 patients (55%). Presentation with preoperative seizures was highly associated with continued seizure burden post-operatively, independent of the extent of surgical resection. Supratentorial location and the administration of prophylactic pre- and post-operative AEDs were associated with Engel Class I seizure freedom. Temporal location was not significantly associated with medically refractory epilepsy compared with extra-temporal locations. Conclusions: In our cohort of pediatric LGGs, we find that patients that did not initially present with seizures and those who were treated with prophylactic pre- and post-operative AEDs, were more likely to achieve Engel Class I seizure freedom post-operatively. Tumors located in the temporal location were not significantly associated with a higher seizure burden than other supratentorial, extra-temporal tumors. Neither extent of resection nor electrocorticography-guided resection correlated with improved seizure freedom outcomes during glioma resection. Cureus 2022-11-26 /pmc/articles/PMC9792195/ /pubmed/36579273 http://dx.doi.org/10.7759/cureus.31915 Text en Copyright © 2022, Budnick et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurology
Budnick, Hailey C
Baygani, Shawyon
Easwaran, Teresa
Vortmeyer, Alexander
Jea, Andrew
Desai, Virendra
Raskin, Jeffrey
Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas
title Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas
title_full Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas
title_fullStr Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas
title_full_unstemmed Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas
title_short Predictors of Seizure Freedom in Pediatric Low-Grade Gliomas
title_sort predictors of seizure freedom in pediatric low-grade gliomas
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792195/
https://www.ncbi.nlm.nih.gov/pubmed/36579273
http://dx.doi.org/10.7759/cureus.31915
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