Seizure in Children with Brain Tumour: A Retrospective Analysis and A Proposal for A Future Study

Background/Objectives: There is no consensus on the treatment and its withdrawal of brain tumour related epilepsies in children and young people. We describe the experience of epileptic seizures in children with brain tumours treated in a neuro-oncology centre, the related risk factors, the seizure treatments and the withdrawal of antiepileptic drugs (AEDs). Design/Methods: Retrospective case note review of 120 newly diagnosed brain tumour patients referred between 01/2010 and 12/2014 to the regional paediatric neuro-oncology service was carried out to determine patient, tumour, seizure characteristics, their treatment and outcomes Results: Data on 117/120 (98%) children and young people were analysed: 67 were male (57%), median age at tumour presentationwas 8.1 years (IQR 25◦-75◦ : 3.6-12.7) with median follow up: 33 months (IQR 25◦-75◦: 24-56). Anatomical distribution was posterior fossa 36%, cerebral hemisphere 28%, supratentorial midline 24%, spinal cord 5%, metastatic 7%. 35/117 (29%) experienced seizures. A significant risk factor for seizure occurrence was a cortical tumour location (OR: 7.1 IC 95% 2.9-17.3). 24 months (IQR25◦-75◦ : 15-48) was the median seizure follow up: 15/35 (43%) were seizure free (SF) on AEDs, 13/35 (37%) were SF and off AEDs, and 7/35 (20%) experienced continuing epileptic seizures. 34/35 (97%) were treated with AEDs. 12/34 (35%) patients withdraw AED. 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). 4/34 (12%) had seizure relapse, all after further acute events. Conclusions: We suggest that AEDs are withdrawn after a period of three months seizure freedom, in particular in children with only one acute symptomatic seizure, and an uncomplicated course, without on-going epileptogenic complications. This time of withdrawal is proposed as a service evaluation target for future studies Acknowledgements: Prof Richard Grundy, Dr SophieWilne, EMCYPICS, and Children's Brain Tumour Research Centre (Nottingham)