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Evaluation of the Epileptic Cases with Intracranial Space Occupying Lesion During Post Operative Period

Year 2009, Volume: 16 Issue: 2, 125 - 130, 01.04.2009

Abstract

Of the patients with cranial tumour 30 to 50% have generalised, partial or secondary generalisedseizures. Partial seizures let us to estimate the tumour localisation. In patients with space occupying lesion seizures may continue after the exicion of the tumour. We evaluatedthe post operative period of the patients who had intracranial tumuor. There were 6 patients ( 3 male) whom were operated for their intracranial space occupying lesions between 18-70 ages. All had epileptic seizures preoperatively exept one patient with hyphophysis adenoma.Of these, the duration with seizure onset between operation were minimum one month and maximum five years.Focal motor seizures, partial andsecondary generalised seizures were seen preoperatively. Post operative diagnoses were menengioma.2, astrositoma.1 oligodendroglioma1, glial tumour1 and hyphophysis adenoma1. Neurologic deficit were not seen any of the patients post operatively. The follow up period after operation were minimum 6 months and maximum 9 years. Four patients were operated for the second time who had the diagnosis of menengioma, astrositoma, oligodendroglioma,and hyphophysis adenoma. Seizure characteristics were changed and the seizure frequency were decreased of the patient who had glial tumourafter post operative period.Maximum seizure free period were 6 years. The menegioma patient had her seizures early in time in intensive care unit as focal motor seizures and no decrease were seen in seizure frequency during the post operative follow up.In parasagittal oligodendroglioma patient seizure frequency were increased post operatively. Four patients had poly therapy. Post operative seizure course is associated with the tumour localisation, size, pathologic diagnosis, and second or more operation.Of these patients it is conspicuousthat the seizure control is more difficult who were operated for the second or more times. Key words: epilepsy, intracranial space occupying lesions, post operative status, anticonvulsant treatments

References

  • Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993; 34: 453–68.
  • Glantz MJ, Cole BF, Forsyth PA, et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 54: 1886–93.
  • Taphoorn MJ. Neurocognitive sequelae in the treatment of lowgradegliomas. Semin Oncol 2003; 30: 45–8.
  • Herman ST. Epilepsy after brain insult: targeting epileptogenesis. Neurology 2002; 59 (suppl 5): 21–6.
  • Wen PY, Marks PW. Medical management of patients with brain tumors. Curr Opin Oncol 2002; 14: 299–307.
  • Van Veelen ML, Avezaat CJ, Kros JM, van Putten W, Vecht C. Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 1998; 64: 581–7.
  • Cascino GD. Epilepsy and brain tumors: implications for
  • treatment. Epilepsia 1990; 31
  • Pasquier B, Peoc’H M, Fabre-Bocquentin B, et al. Surgical (suppl 3): 37–44.
  • pathology of drug-resistant partial epilepsy. A 10-year-experience
  • with a series of 327 consecutive resections. Epileptic Disord 2002; 4: 99–119.
  • Moots PL, Maciunas RJ, Eisert DR, Parker RA, Laporte K, Abou-Khalil B. The course of seizure disorders in patients with malignant gliomas. Arch Neurol 1995; 52: 717–24.
  • Chang EF, Potts MB, Keles GE, Lamborn KR, Chang SM, Barbaro NM, Berger MS Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg. 2008 Feb;108(2):227-35.
  • Lieu AS, Howng SL. Intracranial meningiomas and epilepsy:
  • incidence, prognosis and influencing factors. Epilepsy Res 2000; 38: 45–52.
  • Sirven JI, Wingerchuk DM, Drazkowski JF, Lyons MK, Zimmerman RS. Seizure prophylaxis in patients with brain tumors: a metaanalysis.Mayo Clin Proc 2004; 79: 1489–94.
  • Schaller B. Infl uences of brain tumor-associated pH changes and hypoxia on epileptogenesis. Acta Neurol Scand 2005; 111: 75–83.
  • Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir (Wien) 2000; 142: 1–15.
  • Aronica E, Yankaya B, Jansen GH, et al. Ionotropic and metabotropic glutamate receptor protein expression in glioneuronal tumours from patients with intractable epilepsy. Neuropathol Appl Neurobiol 2001; 27: 223–37.
  • Morrell F, Toledo-Morrell L. From mirror focus to secondary epileptogenesis in man: an historical review. Adv Neurol 1999; 81: 11–23.
  • Mahaley MS Jr, Dudka L. The role of anticonvulsant medications in the management of patients with anaplastic gliomas. Surg Neurol 1981; 16: 399–401.
  • Cohen N, Strauss G, Lew R, Silver D, Recht L. Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988; 6: 1621–4.
  • Wick W, Menn O, Meisner C, et al. Pharmacotherapy of epileptic seizures in glioma patients: who, when, why and how long? Onkologie 2005; 28: 391–6.
  • North JB, Penhall RK, Hanieh A, Frewin DB, Taylor WB.
  • Phenytoin and postoperative epilepsy. A double-blind study. J Neurosurg 1983; 58: 672–7.
  • Wagner GL, Wilms EB, Van Donselaar CA, Vecht C.
  • Levetiracetam: preliminary experience in patients with primary brain tumours. Seizure 2003; 12: 585–6.
  • Vecht CJ, Wagner GL, Wilms EB. Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2003; 2: 404–9.
  • Khan and Onar A, Seizure Recurrence and Risk Factors after Antiepilepsy Drug Withdrawal in Children with Brain Tumors Epilepsia 2006, 47(2):375–9.
  • Britton JW, Cascino GD, Sharbrough FW, Kelly PJ. Low-grade glial neoplasms andintractable partial epilepsy: efficacy of surgical treatment. Epilepsia 1994; 35: 1130–5.
  • Matricardi M, Brinciotti M, Bnedetti P. Outcome after discontinuation of antiepileptic drug therapy in children with epilepsy. Epilepsia 1989; 30:582-9.
  • Hildebrand J. Management of epileptic seizures. Curr Opin Oncol 2004; 16: 314–7.
  • Khan RB, Hunt DL, Boop FA, et al. Seizures in children with primary brain tumors: incidence and long-term outcome. Epilepsy Res 2005;64:85–91.
  • 28-Zaatreh MM, Firlik KS, Spencer DD, et al. Epilepsy: characteristics and predictors of surgical outcome. Neurology 2003;61: 636-41.

İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme

Year 2009, Volume: 16 Issue: 2, 125 - 130, 01.04.2009

Abstract

Beyin tümörlü hastaların %30-50 sinde jeneralize, parsiyel veya parsiyel başlayıp jeneralize olannöbetlere rastlanır. Parsiyel nöbetler tümör yerinin belirlenmesinde yardımcıdır. Yer kaplayan lezyonu (YKL) olan hastalarda lezyonun eksizyonu sonrasında da nöbetler devam edebilir. Burada intrakranyal tümoral lezyonu olan hastaların operasyon sonrası izlemleri değerlendirilmiştir Yaşları 18-70 arasında değişen intrakranyal yer kaplayan lezyon nedeni ile opere olan 3'ü erkek toplam 6 hasta mevcuttu. Bunlardan hipofiz adenomu tanısı alan 1 erkek hasta dışında hepsinin preoperatif dönemde epileptik nöbet öyküsü vardı. Diğer 5 hastada nöbet başlangıcı ve operasyon arası süre 1 ay ila 5 yıl idi. Preoperatif nöbet özellikleri fokal motor nöbet, kötü koku ile karakterize basit parsiyel nöbet ve sekonder jeneralize nöbetler şeklinde idi. Post operatif tanı 2 hastada menengiom, 1 astrositom, 1 oligodendrogliom, 1glial tm ve 1 hipofiz adenomu idi. Post operatif dönemde hiçbir hasta da nörolojik defisit oluşmadı. Post operatif izlem süresi 6 ay ila 9 yıl idi. Astrositom, Oligodendrogliom, Menengiom ve Hipofiz adenomu tanısı alan 4 hasta 1 ila 4 yıl arayla ikinci kez opere edilmişti.Glial tümör tanısı alan 50 yaşındaki bayan hastada post operatif dönemde nöbetler azalmakla beraber karakteristiği değişti. Post operatif en uzun nöbetsizlik süresi 6 yıl idi. Post operatif en erken nöbet, menengioma tanısı alan 1 hastada, yoğun bakımda fokal motor nöbet şeklinde idi. Bu hastanın pre ve post operatif dönemde nöbet sıklığında değişiklik olmadı. Parasagittal oligodendrogliom nedeni ile opere olan 18 yaşındaki bayan hasta da post operatif dönemde nöbet sıklığında artış gözlendi. 2 hastada antiepileptik tedavimonoterapi, 4 hastada politerapi şeklinde devam ediyordu. İntrakranyal tümoral lezyonu olan epileptik hastalarda post operatif nöbet seyri lezyonun yeri, büyüklüğü, patolojik tanısı, geçirilen operasyon ile ilişkilidir. Bu hastalardan ikinci kez opere olanların nöbet kontrolünün daha güç olduğu dikkat çekicidir. Anahtar kelimeler: Epilepsi, İntrakranyal Yer Kaplayan Lezyonlar, Post Operatif Dönem, Antikonvülzan Tedavi

References

  • Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993; 34: 453–68.
  • Glantz MJ, Cole BF, Forsyth PA, et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 54: 1886–93.
  • Taphoorn MJ. Neurocognitive sequelae in the treatment of lowgradegliomas. Semin Oncol 2003; 30: 45–8.
  • Herman ST. Epilepsy after brain insult: targeting epileptogenesis. Neurology 2002; 59 (suppl 5): 21–6.
  • Wen PY, Marks PW. Medical management of patients with brain tumors. Curr Opin Oncol 2002; 14: 299–307.
  • Van Veelen ML, Avezaat CJ, Kros JM, van Putten W, Vecht C. Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 1998; 64: 581–7.
  • Cascino GD. Epilepsy and brain tumors: implications for
  • treatment. Epilepsia 1990; 31
  • Pasquier B, Peoc’H M, Fabre-Bocquentin B, et al. Surgical (suppl 3): 37–44.
  • pathology of drug-resistant partial epilepsy. A 10-year-experience
  • with a series of 327 consecutive resections. Epileptic Disord 2002; 4: 99–119.
  • Moots PL, Maciunas RJ, Eisert DR, Parker RA, Laporte K, Abou-Khalil B. The course of seizure disorders in patients with malignant gliomas. Arch Neurol 1995; 52: 717–24.
  • Chang EF, Potts MB, Keles GE, Lamborn KR, Chang SM, Barbaro NM, Berger MS Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg. 2008 Feb;108(2):227-35.
  • Lieu AS, Howng SL. Intracranial meningiomas and epilepsy:
  • incidence, prognosis and influencing factors. Epilepsy Res 2000; 38: 45–52.
  • Sirven JI, Wingerchuk DM, Drazkowski JF, Lyons MK, Zimmerman RS. Seizure prophylaxis in patients with brain tumors: a metaanalysis.Mayo Clin Proc 2004; 79: 1489–94.
  • Schaller B. Infl uences of brain tumor-associated pH changes and hypoxia on epileptogenesis. Acta Neurol Scand 2005; 111: 75–83.
  • Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir (Wien) 2000; 142: 1–15.
  • Aronica E, Yankaya B, Jansen GH, et al. Ionotropic and metabotropic glutamate receptor protein expression in glioneuronal tumours from patients with intractable epilepsy. Neuropathol Appl Neurobiol 2001; 27: 223–37.
  • Morrell F, Toledo-Morrell L. From mirror focus to secondary epileptogenesis in man: an historical review. Adv Neurol 1999; 81: 11–23.
  • Mahaley MS Jr, Dudka L. The role of anticonvulsant medications in the management of patients with anaplastic gliomas. Surg Neurol 1981; 16: 399–401.
  • Cohen N, Strauss G, Lew R, Silver D, Recht L. Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988; 6: 1621–4.
  • Wick W, Menn O, Meisner C, et al. Pharmacotherapy of epileptic seizures in glioma patients: who, when, why and how long? Onkologie 2005; 28: 391–6.
  • North JB, Penhall RK, Hanieh A, Frewin DB, Taylor WB.
  • Phenytoin and postoperative epilepsy. A double-blind study. J Neurosurg 1983; 58: 672–7.
  • Wagner GL, Wilms EB, Van Donselaar CA, Vecht C.
  • Levetiracetam: preliminary experience in patients with primary brain tumours. Seizure 2003; 12: 585–6.
  • Vecht CJ, Wagner GL, Wilms EB. Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2003; 2: 404–9.
  • Khan and Onar A, Seizure Recurrence and Risk Factors after Antiepilepsy Drug Withdrawal in Children with Brain Tumors Epilepsia 2006, 47(2):375–9.
  • Britton JW, Cascino GD, Sharbrough FW, Kelly PJ. Low-grade glial neoplasms andintractable partial epilepsy: efficacy of surgical treatment. Epilepsia 1994; 35: 1130–5.
  • Matricardi M, Brinciotti M, Bnedetti P. Outcome after discontinuation of antiepileptic drug therapy in children with epilepsy. Epilepsia 1989; 30:582-9.
  • Hildebrand J. Management of epileptic seizures. Curr Opin Oncol 2004; 16: 314–7.
  • Khan RB, Hunt DL, Boop FA, et al. Seizures in children with primary brain tumors: incidence and long-term outcome. Epilepsy Res 2005;64:85–91.
  • 28-Zaatreh MM, Firlik KS, Spencer DD, et al. Epilepsy: characteristics and predictors of surgical outcome. Neurology 2003;61: 636-41.
There are 34 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Sibel Canbaz Kabay This is me

Handan Özışık Karaman This is me

Oğuz Erdinç This is me

Ramazan Durmaz This is me

Publication Date April 1, 2009
Published in Issue Year 2009 Volume: 16 Issue: 2

Cite

APA Kabay, S. C., Karaman, H. Ö., Erdinç, O., Durmaz, R. (2009). İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme. Journal of Turgut Ozal Medical Center, 16(2), 125-130.
AMA Kabay SC, Karaman HÖ, Erdinç O, Durmaz R. İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme. J Turgut Ozal Med Cent. April 2009;16(2):125-130.
Chicago Kabay, Sibel Canbaz, Handan Özışık Karaman, Oğuz Erdinç, and Ramazan Durmaz. “İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme”. Journal of Turgut Ozal Medical Center 16, no. 2 (April 2009): 125-30.
EndNote Kabay SC, Karaman HÖ, Erdinç O, Durmaz R (April 1, 2009) İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme. Journal of Turgut Ozal Medical Center 16 2 125–130.
IEEE S. C. Kabay, H. Ö. Karaman, O. Erdinç, and R. Durmaz, “İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme”, J Turgut Ozal Med Cent, vol. 16, no. 2, pp. 125–130, 2009.
ISNAD Kabay, Sibel Canbaz et al. “İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme”. Journal of Turgut Ozal Medical Center 16/2 (April 2009), 125-130.
JAMA Kabay SC, Karaman HÖ, Erdinç O, Durmaz R. İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme. J Turgut Ozal Med Cent. 2009;16:125–130.
MLA Kabay, Sibel Canbaz et al. “İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme”. Journal of Turgut Ozal Medical Center, vol. 16, no. 2, 2009, pp. 125-30.
Vancouver Kabay SC, Karaman HÖ, Erdinç O, Durmaz R. İntrakranyal Yer Kaplayan Lezyonlu Epileptik Olgularda Postoperatif Değerlendirme. J Turgut Ozal Med Cent. 2009;16(2):125-30.