SEIZURES IN CHILDREN WITH SUPRATENTORIAL ASTROGLIAL NEOPLASMS

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).