We reviewed the records of 98 consecutive patients, 18 years of age or
younger, with pathologically confirmed supratentorial astroglial neop
lasms at the Children's Hospital, Boston, to evaluate the importance o
f seizures in their presentation and natural history. Tumors were diag
nosed using the WHO criteria as pilocytic astrocytomas, astrocytomas,
anaplastic astrocytomas, glioblastomas, giant cell glioblastomas, olig
oastrocytomas and gangliogliomas. Our results were as follows. (1) Fif
ty percent of children had seizures as part of their presentation and
30% had seizures as their only presenting phenomenon. (2) The seizures
varied in nature, but complex (55%) or simple (28%) partial seizures
were by far the most common types, occurring in 77% of cases. (3) Preo
perative electroencephalography (EEG) accurately lateralized to the tu
mor side in 88% of the cases and localized to the correct lobe in 56%.
(4) Tumors involving cerebral cortex significantly correlated with se
izures at presentation as compared to noncortical locations; 59% of pa
tients with cortical tumors presented with seizures, and only 15% of p
atients with noncortical tumors experienced seizures. Lesions in the t
emporal and frontal lobes had the highest incidence of seizures. (5) P
atients with gangliogliomas and oligoastrocytomas had the highest inci
dence of seizures, 88 and 86%, respectively, whereas patients with ana
plastic astrocytoma had the lowest incidence, 21%. (6) Histopathologic
calcification was associated with seizures at presentation approachin
g significance (p = 0.06). (7) Seizures at presentation were significa
ntly associated with good prognosis (p = 0.02).