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From the Brain and Behavior Program (Drs. Nolan, Otsubo, Snead, and Weiss), Division of Neurology, Department of Pediatrics, Department of Pathology (Drs. Sakuta and Hawkins), Department of Diagnostic Imaging (Dr. Chuang), and Department of Neurosurgery (Dr. Rutka), The Hospital for Sick Children, Toronto, Canada.
Address correspondence and reprint requests to Dr. Shelly Weiss, Division of Neurology, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1 x 8, Canada; e-mail: shelly.weiss{at}sickkids.ca
Background: Dysembryoplastic neuroepithelial tumors (DNTs) are associated with medically intractable epilepsy and a favorable prognosis after surgical resection. The authors describe the clinical, radiologic, and pathologic characteristics and outcomes in children after surgical resection of pathologically confirmed DNT to ascertain prognostic features for seizure recurrence following surgery.
Methods: Neurology, neurosurgery, and pathology databases from 1993 to 2002 at the Hospital for Sick Children were searched to retrospectively identify children with confirmed DNT and presentation with seizures. Risk factors for postoperative seizure recurrence were examined with respect to seizure outcome at 12 months and long-term follow-up.
Results: Of the 26 children identified (mean age at surgery 10.0 years) seizure outcome was good in 22 children (85%) at 12 months (Class 1). At longer follow-up (mean 4.3, range 1.0 to 11.0 years) only 16 (62%) remained seizure-free. Residual DNT was evident in 15 of the 24 children with available postoperative MRI. Three children demonstrated recurrence of tumor. At 12 months follow-up, older age (>10 years) and longer duration of epilepsy (>2 years) were associated with seizure recurrence. The presence of residual tumor was a risk factor for seizure recurrence at long-term follow-up (p = 0.02).
Conclusions: Children with DNT and epilepsy may benefit from surgical management; however, seizure outcome is not always favorable. Although the majority of children remain seizure free after surgical excision of DNT, a considerable number have recurrent seizures. Short-term outcome is influenced by older age at surgery and longer duration of epilepsy. Residual tumor is a significant risk factor for poor seizure outcome. Recurrent tumor can occur.
Received January 8, 2004. Accepted in final form February 17, 2004.
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R. Sakuta, H. Otsubo, M. A. Nolan, S. K. Weiss, C. Hawkins, J. T. Rutka, N. A. Chuang, S. H. Chuang, and O. Carter Snead Recurrent Intractable Seizures in Children With Cortical Dysplasia Adjacent to Dysembryoplastic Neuroepithelial Tumor J Child Neurol, March 1, 2004; 19(3): 377 - 384. [Abstract] [PDF]
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