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G392(P) A Regional paediatric neuro-oncology cohort study of seizure characteristics and their management: a proposal for service evaluation criteria
  1. C Pilotto,
  2. WP Whitehouse,
  3. JF Liu,
  4. R Grundy,
  5. S Wilne,
  6. D Walker
  1. 1Medical and Biological Science Department, University of Udine, Udine, Italy
  2. 2School of Medicine, University of Nottingham, Nottingham, UK
  3. 3Department of Paediatric Neurology, University of Nottingham, Nottingham, UK
  4. 4Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
  5. 5Queen’s Medical Centre, Nottingham University Hospitals’ NHS Trust, Nottingham, UK

Abstract

Aims To describe the presentation of epileptic seizures, the tumour-related risk factors, seizure treatments used and the timing of withdrawal of anti-epileptic drugs (AEDs).

Methods Retrospective case note review of 120 newly diagnosed brain tumour patients referred between 01/2010 and 12/2014 to the regional paediatric cancer service was carried out to determine patient, tumour, seizure characteristics and their treatment and outcomes. Statistical analyses using Fischer Test, Mann-Whitney U test and logistic regression test of association between variables were performed.

Results Two patients with tuberous sclerosis and associated seizures and 1 patient lost to follow up, were excluded. 67/117 (57.3%) were male, median age at tumour presentation was 8.1 years (IQR 25°–75°: 3.6–12.7). Anatomical distribution was posterior fossa 36%, cerebral hemisphere 28%, supratentorial midline 24%, spinal cord 5%, metastatic 7%. Most common histological types include pilocytic astrocytoma 15%, visual pathway glioma 8%, other low grade astrocytoma 11%; high grade glioma 10%, medulloblastoma 11%.

With a median follow up of 33 months (IQR 25°–75°: 24–56), there were 35 patients (29%) with seizures. Logistic regression analysis identified cerebral hemisphere localization as risk factor for seizures (OR: 7.07 IC 95% 2.89–17.3). In particular, neither age at diagnosis nor tumour type were associated with seizure risk, although 6/8 patients with glioneuronal tumours developed seizures.

With a median follow up of 24 months (IQR25°-75°: 15–48) 37% were seizure free (SF) off AEDs, 43% were SF on AEDs and 20% experienced continuing seizures. One patient was untreated, seizures resolved.

12 patients withdrew AEDs, median duration of AED therapy 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). 4 children had seizure relapse after further acute events (2 had acute hydrocephalus, 1 had sepsis, 1 had ventriculitis after shunt revision).

Conclusions Epileptic seizures affect about 1/3rd of children presenting with brain tumours, most commonly in cortically-located tumours. The low risk of recurrent seizures after treatment justifies early withdrawal of AED after stabilisation of seizures. A 3 month seizure free interval prior to AED withdrawal is proposed as a service evaluation target for future studies.

Acknowledgement: on behalf of the East Midlands Children and Young People’s Integrated Cancer Service (EMCYPICS) and University of Nottingham Children’s Brain Tumour Research Centre (www.cbtrc.org)

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