Abstracts

Patients with intractable epilepsy who undergo surgery have a 10-20% incidence of CNS neoplasms and the overall incidence of neoplastic lesions among all epilepsy patients has been reported at 4.1%. The purpose of this study is to evaluate tumor related epilepsy from the epileptologist[rsquo]s perspective and characterize patients with tumor related epilepsy. The UVA Epilepsy Database was queried for patients with brain tumors. Tumor type and grade were identified by review of database information, clinic notes, radiology reports, discharge summaries, and pathology results. Out of 1674 patients in the database, 615 were categorized as symptomatic localization related epilepsy (SLRE) and 55 of these had brain tumors (3.3% of all patients in the database and 8.9% of SLRE). 26 of the 55 tumor patients had gliomas and 29 had non-glial tumors. For all tumor patients the average current age was 42.4 [plusmn] 14.2 years, age of seizure onset was 28.2 [plusmn] 17.3 years, duration of epilepsy was 14.5 [plusmn] 13.0 years, number of antiepileptic drugs (AEDs) tried was 4.1 [plusmn] 2.6, and current number of AEDs used was1.8 [plusmn] 1.3. Male to female ratio was 31:29. A history of status epilepticus was present in 7 (12.5%). A breakdown of patients by tumor type and grade is illustrated in table 1. No statistical differences between glial and non-glial tumor patients were found. Tumor type or grade did not predict refractoriness to AEDs or risk of status epilepticus. Among patients with SLRE close to 10% have brain tumors. Tumor type or grade did not predict the degree of refractoriness, although this may be due to the small sample size. Tumor patients of all types required multiple AED trials and often polypharmacy. Epileptologists are most familiar with the management of refractory epilepsy and this study suggests that their participation in the care of tumor patients may be of benefit and should routinely be considered. Seizures may significantly impair the quality of life of many of these patients and if the initial AED trial is ineffective a referral to an epilepsy center is warranted for aggressive medical and potentially surgical treatment of seizures.[table1]