Epilepsy in cystic lesions of the pineal region in childhood

Background: Lesions of the pineal gland constitute 0, 4-I, 0% of all intracranial tumors. The most common clinical symptoms related are headache, vertigo, visual disturbances and less often vomiting, ophthalmic symptoms and epilepsy. So far details on epileptic seizures were not presented. The aim of this study is to present clinical characteristics of epilepsy and EEG findings in five children with cystic lesions of the pineal region. Method: The patients are two boys and three girls aged I I to IS years with epilepsy as presenting symptom. All examinees had MRI verified cystic lesion of the pineal region. Diagnostic work up excluded all other possible etiology for symptomatic epilepsy. The size of the lesions varied from 8xAx 10 mm to ISx 12x 10 mm in diameter. Results: Three children had generalized epilepsy (absance, grand mal). one had secondary generalized and one partial complex seizures. All children had abnormal epileptic EEG recordings ranging from focal spike or sharped-waves to diffuse paroxismal polyspike, spikewaves complexes and were put on valproate therapy. Stabilization of epilcptic scizures in all children was obtained over 6 months to 2 ycars follow-up period. On subsequent MRI examination in six months intervals no changes were noticed in comparison to initial findings. Therefore neurosurgical intervention wasn't considered as yet necessary and clinical, EEG and MRI follow up was recommended. Conclusion: In our patients, children with MRI verified cystic Iesions of the pineal region epileptic seizures were absance, grand mal, partial complex and partial seizures with secondary generalization. Epilepsy was stabilized by administration of antiepileptic drug.