Epilepsy & Treatment

Biography

Biography: Pranshu Bhargava

Abstract

Introduction: Dysembryoplastic neuroepithelial tumor (DNET) is a rare cause of intractable epilepsy and has excellent results in terms of seizure control, after surgical resection. We present one such case, because of its rarity and to highlight the effect of tumor removal on seizure control, particularly for DNET.

Materials and methods /Case summary: A 9-year-old male patient presented with sudden onset partial seizures for the past six months. there were 5 episodes. Each episode patient had irrelevant talk followed by deviation of mouth to left and twitching movements. The episode lasted 5 minutes and there was no loss of consciousness. There was no aura or tongue bite, in one of the episode’s patient lost consciousness. There was no other significant positive history. On examination child was conscious alert oriented, without focal neurological deficit or features of meningitis. There was no papilledema. Patient was on phenytoin sodium, phenobarbitone and clobazam Magnetic Resonance Imaging(MRI) of brain was done with and without contrast. MRI revealed a lesion about 4.1*3.6*3.2 cm in the right medial temporal lobe. It was hypo intense to brain on T1 and FLAIR, hyper intense on T2 weighted images. Diffusion restriction was present and there was minimal contrast uptake. There was no evidence of mass effect or midline shift After discussing the risks and benefits with parents, patient underwent Pre anesthetic checkup and was taken up for craniotomy and excision of tumor. Gross total excision was done. Child was started orally on Day 1 post operatively and ambulated. there were no further seizure episodes. Patient was continued on phenytoin and clobazam, phenobarbitone was tapered gradually. At 6 months’ child was seizure free.

Conclusions: DNET are rare tumors occurring early in life, presenting with intractable seizures. Surgical resection offers a good and safe chance to long term seizure control.