Hi, my name is Virendra Desai, and I'll be talking about predictors of seizure freedom in pediatric low-grade gliomas. In pediatric low-grade gliomas, seizures are the most common presenting symptom, occurring in 1% to 3% of epilepsy patients, being more seizuregenic than other tumor types and often being medically refractory. And these seizures can significantly impair quality of life. Surgical resection can be curative and lead to seizure freedom. In the adult literature, several predictors of postoperative seizure freedom have been identified, including the extent of resection, preoperative seizure control with antiepileptic medications, shorter preoperative seizure duration, tumor location, and age. Thus, we sought to identify similar predictors in a pediatric population. We conducted a retrospective chart review of all grade 1 and 2 gliomas in patients less than 18 over a 10-year time period at Riley Hospital for Children, excluding infertentorial and purely intraventricular lesions. We gathered data on tumor characteristics, seizure status at presentation, antiepileptic medication used pre- and postoperatively, and extent of surgical resection. We performed a chi-square analysis comparing angle class 1 to angle classes 2 through 4 for each of the variables above. The mean age in this study was 9.9 years, with 19 males and 24 females. 60% presented with uncontrolled seizures. About 2 thirds were taking antiepileptic medications pre- and postoperatively. And 60% gross total resection was achieved, with about 1 third having subtotal resection. About half of the patients had concurrent chemotherapy or radiation, and about half suffered recurrence during this study's time period. About half of the tumors were JPAs, and there was a nearly even split between grades 1 and 2 and left versus right. The majority of tumors were located in the temporal and frontal regions. Average follow-up time was 4.9 years. For the 19 patients that had progression, average progression-free survival was 2.9 years. And overall survival for the two mortalities in this cohort was 3.8 years. At last clinical follow-up, 63% achieved angle class 1. Upon chi-square analysis comparing angle class 1 versus 2 through 4, presentation with uncontrolled seizures was a poor predictor of attaining seizure freedom, as were pre- and postoperative requirements for anti-epileptic medications. Notably, age, seizure duration, gross total resection, and tumor characteristics were not significant. Though gross total resection was not a predictor of seizure freedom, it did show a trend towards increased progression-free survival. Whereas anti-epileptic medication used pre- or postoperatively did not have an association with progression-free survival. Overall, we found 63% attaining seizure freedom in line with previous studies. We found that patients presenting with uncontrolled seizures who required anti-epileptic medications pre- or postoperatively had higher risk of continued seizure burden postoperatively. In previous pediatric studies, no preoperative seizures bodes well for continued seizure freedom postoperatively. And immediate postoperative seizures significantly increased the risk of future seizures. Importantly, gross total resection was not a predictor of seizure freedom in this study. Previous studies in both pediatric and adult patients have shown that obtaining 80% to 90% resection is a strong predictor of attaining seizure freedom. And even subtotal resection can lead to a significant proportion of patients achieving seizure freedom. In our study, we did not define to what extent subtotal resection included. Regardless, we hope that these results can help guide clinicians in counseling patients preoperatively and help guide postoperative management. Thank you.

seizure freedom

pediatric low-grade gliomas

predictors

surgical resection

retrospective chart review