Seizure characteristics and the use of anti-epileptic drugs in children and young people with brain tumours and epileptic seizures: Analysis of regional paediatric cancer service population

Chiara Pilotto,Jo-Fen Liu,David A Walker,William P Whitehouse

doi:10.1016/j.seizure.2018.03.016

Abstract

PurposeEpileptic 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). Methodwe undertook a case note review of 120 patients with newly diagnosed brain tumours, referred to a regional paediatric cancer service. Resultsdata was available on 117/120 (98%) children <18 years: median age at tumour presentation was 8.1 years (IQR 25°−75°: 3.6–12.7), median follow up was 33 months (IQR 25°−75°: 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 (IQR25°−75°: 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 (IQR25°−75° 5–14 months), and the median follow up after withdrawal was 15 months (IQR25°−75° 5–34 months). ConclusionsSeizures 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.

Highlights

Epileptic seizures are a common symptom of brain tumours previously reported in 7% to 16% of children and young people in the very limited literature on this topic [1]
The cohort included 120 patients with a new diagnosis of brain tumour in a regional paediatric neuro-oncology service serving a population of 4.5 million. It was representative of the UK population, in terms of tumour histology distribution, compared to cases registered with the Children's Cancer and Leukaemia Group (CCLG)’s national childhood cancer treatment network between 1996 and 2005 (x2: p > 0.05)
Two patients with tuberous sclerosis were excluded because of their previous long history of seizures, and 1 patient was lost in follow up (Fig. 1). 67/117 (57%) were male, median age at tumour presentation was 8.1 years (IQR : 25À75 3.6–12.7)

Summary

Introduction

Epileptic seizures are a common symptom of brain tumours previously reported in 7% to 16% of children and young people in the very limited literature on this topic [1]. Other studies reported a 15–25% incidence [2]. Seizures were reported as the first symptom in 38% of children with supratentorial tumours [3]. Tumour treatment-related toxicity is another important cause of epileptic seizures [6]. A recent study identified individual risk factors for epileptic seizures in children with brain tumours at any time: cortical tumour location, histology as glioneuronal tumour, and low or high grade glioma, incomplete resection, and tumour recurrence [5]

Results

Discussion

Conclusion