Download the Slides:

Description:

In this webinar, Dr. Nir Shimony, a pediatric neurosurgeon at Le Bonheur Children’s Hospital and St. Jude’s Research Hospital, explores the connection between pediatric brain tumors and epilepsy. He explains the difference between seizures and epilepsy, treatment challenges, the role of surgery, the risk of epilepsy developing after tumor treatment, and emerging options. Managing these conditions requires understanding both oncology and epilepsy. Importantly, Dr. Shimony emphasizes that effective solutions exist, even for children whose families are told otherwise. Key Takeaways: 1. Seizures vs. Epilepsy in Children with Brain Tumors

  • A seizure can be a symptom of a brain tumor but does not always indicate epilepsy.
  • Epilepsy involves recurring, unprovoked seizures that are more difficult to control.
  • Seizures may result from tumor growth, recurrence, treatment side effects (e.g., radiation), or interactions with medications.
  • A new seizure in a child with a brain tumor may signal tumor progression.

2. Epilepsy Is More Common Than Many Realize

  • At least 25% of children with brain tumors experience seizures, possibly more.
  • Epilepsy is often associated with low-grade (less aggressive) tumors, not just high-grade ones.
  • Tumor location matters—tumors in the temporal lobe are particularly likely to cause seizures.

3. Tumor Removal Does Not Always Stop Seizures

  • Many assume that removing the tumor will end seizures, but 25-40% of children develop epilepsy even after surgery.
  • Tumors alter surrounding brain tissue, sometimes leading to ongoing seizure activity.
  • Certain low-grade tumors, such as DNETs and gangliogliomas, are strongly linked to epilepsy.

4. Surgery Must Consider Both Tumor Control and Epilepsy

  • Maximal safe resection—removing as much of the tumor as possible while protecting brain function—leads to the best outcomes.
  • A 2023 study found that 90% of patients achieved seizure freedom when epilepsy treatment was prioritized.
  • Multiple surgeries may be safer than attempting aggressive removal in one operation.
  • Phase II EEG (intracranial monitoring) helps identify seizure-causing areas beyond the tumor.
  • “Supra-maximal resection” (removing slightly beyond the visible tumor) may improve seizure control in some cases.

5. Late-Onset Epilepsy After Tumor Treatment

  • 20-40% of children may develop epilepsy months or years after tumor treatment, even if initially seizure-free.
  • Risk factors include:
  • Seizures before surgery
  • Partial tumor removal
  • Radiation therapy
  • Very young age at diagnosis
  • Long-term neurological follow-ups are essential, even if the child is considered cancer-free.

6. When Is Invasive EEG Monitoring Needed?

  • Phase II EEG with intracranial electrodes pinpoints seizure sources, guiding targeted surgery.
  • This is especially useful when epilepsy persists after tumor removal.

7. Minimally Invasive Surgery Options

  • Techniques like laser ablation and depth electrodes offer effective treatment with lower risk and faster recovery.
  • These methods benefit children for whom traditional open brain surgery is too risky.

8. Neuromodulation: A Non-Surgical Treatment for Epilepsy

  • For children who cannot have surgery, devices like:
  • Vagus Nerve Stimulation (VNS)
  • Deep Brain Stimulation (DBS)
  • Responsive Neurostimulation (RNS)

can reduce seizure frequency.

  • These treatments should be pursued at experienced centers for optimal outcomes.

9. Can Cancer Treatments Help Control Seizures?

  • Radiation therapy, especially focal radiation, may help control seizures in non-resectable areas.
  • Targeted drug therapies (e.g., mTOR inhibitors) show promise in reducing seizures by addressing tumor growth.

10. Future Treatments: Personalized Medicine

  • Advancements in genetic and molecular research are leading to more *targeted therapies* for both tumors and epilepsy.

11. Managing Anti-Seizure Medications

  • Routine seizure medications after brain tumor surgery are not always necessary unless epilepsy is pre-existing.
  • If seizure control is achieved, gradual medication withdrawal over several months to a year is standard practice.

Dr. Shimony advocates for a personalized, multidisciplinary approach to treating children with brain tumors and epilepsy. He encourages families to seek expert opinions at specialized centers. Treatment goes beyond tumor removal—advanced surgical techniques, neuromodulation, and long-term monitoring can greatly improve a child’s quality of life.