Abstracts

RATIONALE: To review the clinical, neurophysiologic features and surgical outcomes in patients with frontal lobe tumors and chronic intractable seizures.
METHODS: Medical records of patients with intractable epilepsy who underwent resection or stereotactic biopsy of frontal lobe tumor (confirmed by surgical pathology) seen between 1985 and 1999 at Yale University School of Medicine Epilepsy Center were reviewed for age at diagnosis, age at onset of seizures, delay between seizure onset and tumor diagnosis, types and frequencies of seizures, EEG results, use of anticonvulsants, extent of surgery, pathological diagnosis and tumor recurrence.
RESULTS: Seizures were the presenting symptom in 32/38 patients. Mean age at seizure onset was 31.6 years. Mean age at tumor diagnosis was 36.2 years. Mean duration between onset of seizures and tumor diagnosis was 6.1 years. Seventeen patients had auras. Seizure frequency averaged 7.6 seizures per week with 58% of patients having more than one seizure type. All patients used anticonvulsants with 90% eventually using polytherapy. All patients eventually underwent at least one surgical procedure: 27 patients had gross total resection. 8 patients had subtotal resections due to functional consideration and two had stereotactic biopsy. Only 13 patients (35.1%) were class I seizure free with or without auras. 12 patients were class II (32.5%) .7 patients were class III and 6 patients (16.2%) had no improvement. No statistically significant difference between long-term seizure outcomes and tumor pathology, seizure types or type of resection was found.
CONCLUSIONS: Long term surgical outcomes in tumoral frontal lobe epilepsy are comparable to non-tumoral intractable frontal lobe epilepsy (65 % class I or II) and less favorable than other tumoral epilepsy (overall 70 % class I). Frontal location of intracranial neoplasm may predict a less favorable long-term epilepsy prognosis than tumoral epilepsy in general.