Low-grade epilepsy-associated neuroepithelial tumours (LEATs) encompass the broad
spectrum of tumours associated with epilepsy. Since the postsurgical seizure outcome
in LEATs is favourable, it is speculated that epileptological presurgical evaluation
(EPE) might not be required for patients with LEATs. A multicentre study involving
referring epilepsy and neurosurgery centres was performed, aimed at evaluating postsurgical
epilepsy outcome in patients with LEATs, with and without EPE, including long-term
video-EEG monitoring (vEEGM). In total, 149 surgically treated patients were enrolled
(age: 31±14 years; age at surgery: 26.4±13.1 years; males; 55.7%) with histopathological
confirmation of LEATs and follow-up of more than six months. All patients had undergone
standard assessment: clinical, routine EEG and brain MRI. In addition to vEEGM, EPE
included other additional investigations. Epileptologists did not assess patients
treated in neurosurgical centres. The EPE was performed in 51% of patients. Histopathological
diagnosis revealed ganglioglioma in 43.6%, DNET in 32.9%, pilocytic astrocytoma in
17.4%, and others in 6.1% of patients. The majority of patients were seizure-free
(ILAE epilepsy surgery outcome Class 1; 71.1%). The median follow-up period was 36
months. Patients who were rendered seizure-free were younger (mean age: 24.2±12.2)
than those who were not seizure-free (31.8±14.0) (p=0.001). No difference was identified
between evaluated and non-evaluated patients with respect to seizure freedom (p=0.45).
EPE patients had a longer epilepsy duration (median: 10 years) and a higher proportion
of drug resistance (73.6%) compared to non-evaluated patients (median: two years;
26.4%) (p<0.001). Based on a significant difference in major clinical variables, that
may well affect postoperative results, the similar postsurgical seizure outcome in
groups with and without EPE observed in our study should be considered with caution,
and conclusions as to whether there is value in formal presurgical evaluation in LEAT
patients cannot be drawn. Our data strongly encourage the clear need for continued
discussion around such patients at epilepsy management conferences.
