Management Guidelines for the Treatment of Pediatric Brain Tumor-Associated Seizure: A Modified Delphi Consensus Report.
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OBJECTIVE: Seizures represent a significant source of morbidity for children with brain tumors. The objective of our study was to establish consensus guidelines for managing children with tumor-related epilepsy. METHODS: The study team assembled a panel of 18 child neurologists specializing in neurological complications of brain tumors including neuro-oncologists, general neurologists, and epileptologists. We utilized a modified Delphi consensus-building methodology that started with a systematic review of literature and a closed-ended survey to address the major issues the team felt was essential for the treatment of seizures in pediatric brain tumor patients. Measures of central tendency and percentage of agreement and disagreement were calculated for each question. A second survey was sent with the modal response and one or two additional frequent responses. Modifications were also made to address panelists' suggestions for clarification of the questions. Consensus was defined a priori as > 75% panelist agreement. The majority response was defined as 50%-75% agreement. RESULTS: Respondents universally agreed to start a patient on anti-seizure medication (ASM) only after their first seizure, with levetiracetam as the first-line and lacosamide or oxcarbazepine as the second-line. Consensus was reached for when ASM should be weaned for patients in different scenarios. Electroencephalography (EEG) should be considered prior to weaning medication if the initial EEG was abnormal. Finally, the presence of cortical dysplasia or mesial temporal sclerosis should prompt an upfront epilepsy surgery evaluation. CONCLUSIONS: This study yielded guidelines for pediatric brain tumor-related epilepsy established from the opinions of child neurologists specializing in the care of these patients.