Neurology. Dysembryoplastic Neuroepithelial Tumor (DNET) Dysembryoplastic neuroepithelial tumor is a rare tumor that occurs in children and is characterized by long-standing, intractable partial complex seizures. Status epilepticus did not occur. [citation needed], Children are much more prone to exhibit these dysembryoplastic neuroepithelial tumours than adults. [2], Varying subclasses of DNTs have been presently identified, with dispute existing in the field on how to properly group these classes. Results: Unable to process the form. If it is indeed a DNET, the prognosis is very much better. 2 Clinical Features Most patients pres ent with a long-standing history of partial complex seizures that are poorly responsive or resistant to standard antiepileptic therapy. DNTs have a benign course, but there are some reports with malignant transformation. Problems with retaining saliva One patient had a DNET that involved both frontal and temporal areas. Common age Adults between 15-40 years; com Children beneath 15 years; comprise eighty% of childhood prise 20% of childhood leukaemias leukaemias 2. [4] The most common symptom of DNTs are complex partial seizures. The .gov means its official. I would like to thank all those who helped me investigate the case: Professor Dumitru Constantin, MD, PhD; psychologist Diana Blan from the Clinic of Neurology, Professor Ioan Codorean, MD, PhD; Maria Glman, MD; Adriana Rmbu, MD, from the Medical Imagings and Nuclear Medicine of Central University Military Emergency Hospital, Bucharest. Neuro-Oncology. Only a few number of patients were found to have partial lobe DNET, which can be demonstrated by the EEG. Seizure outcome of lesionectomy in glioneuronal tumors associated with epilepsy in children. Nolan MA, Sakuta R, Chuang N, Otsubo H, Rutka JT, Snead OC, Hawkins CE, Weiss SK: Dysembryoplastic neuroepithelial tumors in childhood: long-term outcome and prognostic features. Focal epilepsy associated with dysembryoplastic neuroepithelial tumor in the area of the caudate nucleus. The tumor usually is circumscribed, wedge-shaped or cystic. National Library of Medicine Tumors that recur are usually low grade; transformation into malignancy is very rare. Two treated cases characterized by an atypical presentation have been reviewed. Dysembryoplastic neuroepithelial tumors (DNET) are proliferative mass of tissue arising from glial cells in the central nervous system commonly presenting in childhood years, though, there have been reports of DNET in adults as well [1], [2], [3].They were first described by Daumas-Duport in 1988 as "a surgically curable tumor of young patients with intractable partial . Bethesda, MD 20894, Web Policies Intractable occipital lobe epilepsy: clinical characteristics, surgical treatment, and a systematic review of the literature. Metastases are most frequently . Accessibility Neuropathology. Surg Neurol. Privacy [1] These are glioneuronal tumours comprising both glial and neuron cells and often have ties to focal cortical dysplasia. 10.1136/jnnp.67.1.97. These numbers are for some of the more common types of brain and spinal cord tumors. Typically these tumors are diagnosed in children or young adults, as a result of the investigation of seizures, which have usually had childhood onset. 2000, 19 (2): 57-62. [2], Three subunits of DNTs have been commonly identified:[2], There currently exists some debate over where to make the proper division for the subunits of DNTs. Rare malignant transformations have been reported, especially in extra-temporal and complex forms. 9. Google Scholar. Contributed by P.J. The radiologist found out by cortical topography and found out with the help of no mass effect and sometimes perilesional edema. These types of treatments affect your whole body. Der Dysembryoplastische neuroepitheliale Tumor (abgekrzt DNET oder DNT) ist ein seltener, gutartiger Hirntumor, der erstmals 1988 von Daumas-Duport beschrieben wurde. As opposed to v-myb avian myeloblastosis viral oncogene homolog, isocitrate dehydrogenase-1/isocitrate dehydrogenase-2 mutation and codeletion 1p-19q, fibroblast growth factor receptor 1 and BRAF V600E mutations are present. Children with brain tumors often have a better prognosis than adults with a similar condition, and most children and adolescents who are diagnosed with a brain tumor will survive. 2016 Jan;126(1):1-10. doi: 10.1007/s11060-015-1961-4. . Approximately one-third of tumors are malignant and the remainder are benign or borderline malignant [ 1,2 ]. ", "A rare case of dysembryoplastic neuroepithelial tumor", https://en.wikipedia.org/w/index.php?title=Dysembryoplastic_neuroepithelial_tumour&oldid=1103971359. same clinical and neuroimaging features as complex DNET, but generally hypointense compared with adjacent brain, enhancement may be heterogeneous or a mural nodule, partial suppression of some of the "bubbles", FLAIR is helpful in identifying the small peripheral lesions with similar intensity to CSF, hemosiderin staining is uncommon as bleeding into DNETs is only occasional, non-specific although lactate may be present, lacking histological specific glioneuronal element (SGNE), tumors (in order of decreasing frequency). 8600 Rockville Pike Activating abnormalities in the MAPK . MeSH Dysembryoblastic neuroepithelial tumor (DNET), a benign, rare tumor of the brain, commonly presents with generalized or partial epilepsy, post-epilepsy sequelae of psychotic, depressive or anxiety symptoms or disorders, or is usually asymptomatic. 2019 Dec;132:347-355. doi: 10.1016/j.wneu.2019.08.221. [3] A headache is another common symptom. Am J Med Genet Part A 173A:10611065. Noninvasive recording and careful mapping show that a structural lesion is not the source of epileptic activity. Federal government websites often end in .gov or .mil. 10.1016/j.ncl.2009.08.003. sharing sensitive information, make sure youre on a federal The Food and Drug Administration require warning labels on the risk of SUDEP in association with the use of each of the above-mentioned drugs [14]. Sleep-related hypermotor epilepsy (SHE) is a group of clinical syndromes with heterogeneous etiologies. Nervous hunger. and transmitted securely. 10. Article Complete surgical resection without any adjuvant treatment remains the treatment of choice. These tumors are seen mostly in children and young adults and patients may present with a long-standing history of seizures. 2007 Dec;21(6):539-49. doi: 10.1080/02688690701594817. MRI revealed a 32.3 mm (anteroposterior)43.1 mm (transverse)28.3 mm (craniocaudal) multicystic cortico-subcortical parietal lesion, divided by septations, without edema or mass effect, and no enhancement (Figure 1, panels B, C, D). Dysembryoplastic neuroepithelial tumour ( DNT, DNET) is a type of brain tumor. "Dr Carol Davila" Department of Neurology, Central Military Emergency University Hospital, Calea Plevnei 134, Bucharest, Romania, You can also search for this author in SUDEP incidence rates vary from 0.35 per 1000 person-years of follow-up in population based studies to 9.3 per 1000 person-years in patients with refractory epilepsy [13]. Neuronal cells in the lesion may also secrete neurotransmitters or express receptors. DNETs are not the same thing as "gliomas" that are frequently mentioned on this board. 2017 Oct 18;49(5):904-909. Accessed September 12, 2018. Bookshelf Neurology. 2010, 68 (6): 898-902. Nervousness Radiographics. National Library of Medicine Google Scholar. Most commonly found in the temporal lobe, DNTs have been classified as benign tumours. The WHO 2021 now classifies gliomas, glioneuronal tumors and neuronal tumors in 6 different families, under which 3 are tumor types consistent with pLGG/LGNT: (1) Pediatric type diffuse low-grade gliomas, (2) circumscribed astrocytic gliomas and (3) glioneuronal and neuronal tumors. Cancers (Basel). This website is intended for pathologists and laboratory personnel but not for patients. A mutual information-based metric for evaluation of fMRI data-processing approaches. Surgery can resolve the seizures. In conclusion, DNET is a benign tumor, composed of neuroglial cell, most probably confined to the temporal lobe. Imaging results. Thus, all efforts should be undertaken to eliminate this seizure including abstract epilepsy surgery. government site. Moore D, Cornejo P, Jorgensen SA, Towbin R. Barkovich J, Raybaud C. Intracranial, Orbital, and Neck Masses of childhood. About the Foundation. Incidence of Adult-Onset Epilepsy and the Contributory Role of Neurocysticercosis in a Five-Year, Population-Based, Prospective Study in Rural Ecuador. The "specific glioneuronal element (SGNE)" is characteristic, and refers to columnar bundles of axons surrounded by oligodendrocyte-like cells which are oriented at right angles to the overlying cortical surface. Treatment for DNT is surgical resection; however, there is no cohort of untreated control patients. As our patient refused to have a cerebral biopsy, we decided to perform a complementary imaging exploration, which could offer us more details about the tumor. Asphyxiation secondary to an obstructive cause has been postulated to play a role in the deaths of patients who were found in a prone position at the time of death [9]. did ali know that baba is hassan's father START UP CAFE@HALU GARDDEN Some of the common ways cancer treatments can affect older adults are explained below. It has been found that if the tumour is removed by performing resections patients are then recognized as seizure free. hyperactivity or difficulty sitting still restlessness or being fidgety While these problems are usually diagnosed in childhood, symptoms sometimes persist into the adult years in many people. From my understanding, the prognosis is good even in non-fully resected cases and chemo and radiation are generally not used in treatment. Cardiac dysrhythmias during the interictal state is another potentially fatal condition because of chronic autonomic dysfunction, effects of antiepileptic medication and a common genetic susceptibility [6, 7]. Rev Neurol. . Other neurological impairments besides seizures are not common. 2015. Methods: DNETs are a mixed glioneuronal neoplasm with a multinodular architecture and a heterogeneous cellular composition. Calcification is visible in ~30% (more common histologically)and is typically visualized in the deepest parts of the tumor, particularly adjacent to enhancing or hemorrhagic areas 8. Our patient was found by her mother in a prone position at the time of death. [2] It has been found that males have a slightly higher risk of having these tumours. (A) First CT scan show a left temporoparietal diffuse hypodense area, quite inhomogeneous without mass effect. This cortical structural abnormality disrupts normal neuronal circuitry and becomes an epileptogenic focus. SHE is difficult to diagnose and treat in the early stages due to its diverse clinical manifestations and difficulties in differentiating from non-epileptic events, which seriously affect patients' quality of life and social behavior. 2020;8(1):21. gliomas, glioneuronal tumors, and neuronal tumors, diffuse astrocytoma, MYB- or MYBL1-altered, polymorphous low-grade neuroepithelial tumor of the young, diffuse low-grade glioma, MAPK pathway-altered, pediatric-type diffuse high-grade gliomas, diffuse hemispheric glioma, H3 G34-mutant, diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype, diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (provisional inclusion), supratentorial ependymoma, ZFTA fusion-positive, supratentorial ependymoma, YAP1 fusion-positive, medulloblastoma, SHH-activated and TP53-wildtype, medulloblastoma, SHH-activated and TP53-mutant, cribriform neuroepithelial tumor (provisional inclusion), CNS tumor with BCOR internal tandem duplication, circumscribed meningeal melanocytic neoplasms, with normal to simplified cortical pattern, microcephaly with extensive polymicrogyria, malformations secondary to inborn errors of metabolism, mitochondrial and pyruvate metabolic disorders, cerebellar hypoplasias, not otherwise specified, focal cerebellar cortical dysplasias/heterotopia, lissencephaly with agenesis of corpus callosum and cerebellar dysplasia, associated with diffuse cerebral polymicrogyria. "WHO Classification of Tumours of the Central Nervous System. Treatment options and prognosis differ significantly between these lesions. J Clin Neurophysiol. Results: dysembryoplastic neuroepithelial tumors (DNET) contrast enhancement uncommon "bubbly appearance" common oligodendroglioma calcifications common older age group: middle-aged adults, most commonly in the 4 th and 5 th decades of life desmoplastic infantile ganglioglioma young children dural involvement prominent large often multiple lesions Clipboard, Search History, and several other advanced features are temporarily unavailable. When each episode concluded, the child became angry, fearful, or affectionate. They characteristically cause intractable focal seizures (see temporal lobe epilepsy). Our patient was not assessed for any sleep disorders which may predispose to SUDEP. [1] The mean age of onset of seizures for children with DNTs is 8.1 years old. Early and complete surgery, with functional studies before and during the surgery, leads to a good control of seizures, avoiding complications such as hemorrhage, malignant transformation and neuropsychological changes, as in our case. Unfortunately, all the studies, (especially the case series) published so far mention only the medium term seizure control but do not refer to the neurological disabilities caused by the surgery. The floating neurons are positive for NeuN 8. Other authors show that seizure outcome is not always favorable. The combination of preoperative positron emission tomographic metabolic studies with functional brain mapping allows for prediction of tumor type, defines eloquent areas of cortical function, and improves approach and resection of the tumors with minimal risk of neurological impairment. Daumas-Duport C, Varlet P: Tumeurs neuroepitheliales dysembryoplasiques. The overall appearance of DNETs varies. Dysembryoplastic neuroepithelial tumour (DNT, DNET) is a type of brain tumor. Routine MRI sequences reveal a well-demarcated lesion, hypointense on T1-weighted images, and hyperintense on T2-weighted images. A fourth subunit is sometimes noted as a mixed subunit. Dysembryoplastic neuroepithelial tumor and probable sudden unexplained death in epilepsy: a case report. Prolonged postictal generalized electroencephalographic suppression, greater than 50 seconds, appears to identify refractory epilepsy patients who are at risk of SUDEP [11]. An official website of the United States government. Patients with refractory epilepsy should have complete sleep disorder and cardiology assessments including electrocardiogram evaluation of cardiac rhythm disturbances, which could be performed at the same time as the EEG. Epub 2012 Jul 17. Epub 2016 Feb 27. [1] Few other neurological deficits are associated with DNTs, so that earlier detection of the tumour before seizure symptoms are rare. 2005;64 (5): 419-27. 8. Become a Gold Supporter and see no third-party ads. By using this website, you agree to our This site needs JavaScript to work properly. To the best of our knowledge, this is the first case of probable sudden unexplained death in symptomatic epilepsy due to dysembryoplastic neuroepithelial tumor with natural history. NCI CPTC Antibody Characterization Program. CDC funded page. Contrast enhancement may be present and a focal cortical dysplasia is commonly associated with it. Five patients required intracranial EEG. One minute of hyperventilation activated a tonic-clonic generalized seizure, accompanied by specific EEG recording (Figure 2). Finally, axial fused PET/CT images demonstrated hypometabolism within the left frontal lobe lesion. For the neurons that are seen in the tumours, it is suggested that they had been trapped within the tumor upon formation, and are not a part of the tumour itself. The survival rates for those 65 or older are generally lower than the rates for the ages listed below. Medications can be given through the bloodstream to reach cancer cells throughout the body. California Privacy Statement, In a study done with Daumas Duport and Varlet, 2003, they have found that there has been one case so far that the tumour has come back, however, in that particular case the patient underwent an incomplete resection, which led them to perform a second surgery in order to remove it completely. The effectiveness of surgery on seizure outcome has been established. In 60% of cases, the event was related to sleep, which might indicate involvement of a sleep-related event. Prayson RA: Bcl-2, bcl-x, and bax expression in dysembryoplastic neuroepithelial Tumors. [5] Most of the tumours observed in patients are benign tumours, and once taken out do not cause neurological deficits. Ann Neurol. [5] Since its prevalence is small among the population, it often goes misdiagnosed or even at times goes undiagnosed. These problems, if left untreated, can affect a person's daily life, work, relationships and more. Mosby Inc. (2003) ISBN:032300508X. 10.1097/WNP.0b013e3181b7f129. The group of tumors, formerly known as PNETs, are Grade IV tumors. DNET was first proposed as a specific entity by Daumas-Duport et al. Childhood brain tumors are less likely to change from low-grade (slow growing, less aggressive) to high-grade (fast growing, more serious). 2005 Apr;102(3 Suppl):288-93. doi: 10.3171/ped.2005.102.3.0288. Bonney PA, Boettcher LB, Conner AK, Glenn CA, Briggs RG, Santucci JA, Bellew MR, Battiste JD, Sughrue ME. Neuronal markers (synaptophysin, neuron- specific enolase) and glial markers (GFAP, S-100) are positive. [3], A dysembryoplastic neuroepithelial tumour is commonly diagnosed in patients who are experiencing seizures with magnetic resonance imaging (MRI), electroencephalogram (EEG). Cite this article. Based on a review of 39 cases, the authors defined a distinct class of slow-growing, supratentorial, glioneuronal tumors in young adults and children. The usefulness of MR imaging in the diagnosis of dysembryoplastic neuroepithelial tumor in children: a study of 14 cases. Srbu, CA. The term DNT was first introduced in 1988 by Daumas-Duport, terming it dysembryoplastic, suggesting a dysembryoplastic origin in early onset seizures, and neuroepithelial to allow the wide range of possible varieties of tumours to be put into the category. Brain Imaging with MRI and CT. Cambridge University Press. It typically presents with epilepsy during childhood. Non-enhancing lesions on MRI were located in the temporal lobe in 17 patients, the frontal lobe in 3 patients and the parietal/occipital region in 2 patients. Dysembryoplastic neuroepithelial tumors: where are we now? PubMed Central CAS Over 100 cases have been reported in the literature since the first description by Daumas-Duport in 1988 [1]. [citation needed]. 11. We shopped around for the right neurosurgeons. Thom M, Gomez-Anson B, Revesz T, Harkness W, O'Brien CJ, Kett-White R, Jones EW, Stevens J, Scaravilli F: Spontaneous intralesional haemorrhage in dysembryoplastic neuroepithelial tumours: a series of five cases. Malignant Transformation of a Dysembryoplastic Neuroepithelial Tumor (DNET) Characterized by Genome-Wide Methylation Analysis. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Med Case Reports 5, 441 (2011). Symptoms depend on the tumor's size, location, how far it has spread, and whether there is brain swelling. Aberrant expression of apoptosis-associated proteins (bcl-2, bcl-x, bax), similar to what has been previously described in gangliogliomas (another epilepsy-related, dysplasia-associated tumor), may play a role in the pathogenesis of DNT [2]. Seventeen patients (74%) had an Engel class 1 outcome, in a follow-up period that ranging from 5 to 98 months. Bale T. FGFR- Gene Family Alterations in Low-Grade Neuroepithelial Tumors. What does it do? DNT has a multinodular architecture, mainly in the cortex, and consists of oligodendrocytes, astrocytes, neurons, and glyconeural elements. This article is published under license to BioMed Central Ltd. [4] EEG are predominantly localized with DNT location in the brain, however there are nonspecific cases in which the location of the tumour is abnormal and not localized. It affects children and adults, and it results in seizure varying in severity from simple partial to generalized seizures. Therapies using medication. Groups lacking glioneuronal elements were not considered to have fallen in the same group and have thusly not yet been classified. [3] The identification of possible genetic markers to these tumours is currently underway. The author declares that they have no competing interests. [2] This news has forced us to take action and he is now going for brain surgery in 3 weeks time. BRAF; Brain neoplasm; DNET; Diffusion-weighted MRI; Drug-resistant epilepsy; MR spectroscopy; Neuroepithelial tumor. Supratentorial intraventricular tumors (SIVTs) represent rare lesions accounting for approximately 1-3% of all intracranial lesions [ 16 , 19 ]. On admission to our clinic, 13 years after the disease onset, neurological examination revealed no positive findings other than neuropsychological abnormalities. No significant mass effect or adjacent edema was identified. . FOIA They are most commonly located in the temporal lobe (over 50-60% of cases) and . 3. Article On CT and MRI, PXAs are characterized by a well-defined peripheral or cortical partially cystic mass most commonly in the temporal lobe. [4] In a study done by Bilginer et al., 2009, looking at patients whose tumour was not completely removed, and saw that they were still experiencing seizures, concluding that the incomplete resection as a being a failure. dnet tumor in older adults. Retrospective cohort of 23 patients seen at two major epilepsy centers, with localization-related epilepsy associated with histopathologically demonstrated DNETs. For more information or to schedule an appointment, call . Epub 2019 Sep 11. Ewing sarcoma tumors most commonly arise in the pelvis, legs or arms of children and young adults. CAS The dysembryoblastic neuroepithelial tumor -DNET is a rare tumor of the central nervous system, neuroglial mixed origin, especially children and young people up to 20 years of supratentorial location in the frontal and temporal lobes mostly. 2012 Oct;114(8):1119-22. doi: 10.1016/j.clineuro.2012.06.003. Although cases of DNET have been observed in young adults, most patients are less than 20 years of age at presentation; there is a male predominance. Types of embryonal tumors include: Medulloblastomas. Dysembryoplastic neuroepithelial tumor s (DNTs) commonly abbreviated DNT or DNET are usually benign tumor s of neuroepithelial origin arising from the cortical gray matter . PathologyOutlines.com website. There can be adjacent regions of cortical dysplasia. Ewing sarcoma. Prepared by Dr. Moore while practicing at Barrow Neurological Insitute, Phoenix, AZ; and Dr. Cornejo, Dr. Jorgensen, and Dr. Towbin while practicing at Phoenix Childrens Hospital, Phoenix, AZ. Tomoscintigraphy (single-photon emission CT) with Tc99m MIBI indicated no tumor metabolic activity. Serotonin might affect respiratory mechanisms and may be involved [10]. Copyright 2019 Elsevier Inc. All rights reserved. Cardiac arrest can cause secondary cardiopulmonary arrest [8]. Other tumors have symptoms that develop slowly. 1,2 Diagnostic criteria include partial seizure disorder that begins before age 20, no neurological deficits, and a cortically based tumor. Status epilepticus did not occur. Sci Rep. 2023 Jan 13;13(1):682. doi: 10.1038/s41598-022-26636-7. https://my.statdx.com/document/dnet/4d5ae76b-1c26-495f-881b-b66a81d21f8a?searchTerm=dnet. Chemotherapy, trastuzumab, and radiotherapy should be provided as routine adjuvant therapy to women with breast cancer . The seizures are known to cause central apnea by direct propagation of the electrical discharge to the respiratory center. The site is secure. [4], Dysembryoplastic neuroepithelial tumours are classified as a benign tumour, Grade I of the World Health Organization (WHO) classification of brain tumours. Schuele SU, Bermeo AC, Alexopoulos AV, Locatelli ER, Burgess RC, Dinner DS, Foldvary-Schaefer N: Video-electrographic and clinical features in patients with ictal asystole. Leadership. About 70-90% of surgery are successful in removing the tumour. PMC official website and that any information you provide is encrypted They demonstrate essentially no growth over time, although a very gradual increase in size has been described. These tumours, with a glial and/or neuronal component, are challenging in terms of diagnosis and therapeutic management. The 2021 WHO Classification of Tumors of the Central Nervous System: A Summary. Honavar M, Janota I, Polkey CE: Histological heterogeneity of dysembryoplastic neuroepithelial tumour: identification and differential diagnosis in a series of 74 cases. Review of seizure outcomes after surgical resection of dysembryoplastic neuroepithelial tumors. No products in the cart. Lathers CM, Schraeder PL: Clinical pharmacology: drugs as a benefit and/or risk in sudden unexpected death in epilepsy?. On CT, DNET can demonstrate wedge-shaped cortical hypoattenuation and mimic ischemia or infection (Figure 1). Typically seen as a cortical lesion with hardly any surrounding vasogenic edema. Article DNT is a newly-described, pathologically benign tumor, arising within the supratentorial cortex. Abdelzaher, E. Dysembryoplastic neuroepithelial tumor (DNET). I'm from Poland. Nashef L, Ryvlin P: Sudden unexpected death in epilepsy (SUDEP): update and reflections. Differentiation of DNT from gangliogliomas or other low grade gliomas is possible using magnetic resonance imaging (MRI) features and is important because DNT does not recur after epilepsy surgery. Journal of Medical Case Reports Unable to load your collection due to an error, Unable to load your delegates due to an error. Federal government websites often end in .gov or .mil. The Brain Tumor Center at Dana-Farber/Boston Children's Cancer and Blood Disorders Center is a world-renowned destination for children with malignant and non-malignant brain and spinal cord tumors. Google Scholar. In adults tumors in the 4th ventricle are uncommon. Patients with refractory epilepsy should be evaluated for any sleep disorders and should have complete cardiology assessments including electrocardiographic evaluation of cardiac rhythm disturbances. Patira R, Nathan C, Zubkov S, Gutierrez C, Munyon C, Mukherjee A, Jacobson M. Epilepsy Behav Case Rep. 2017 Sep 12;8:92-95. doi: 10.1016/j.ebcr.2017.09.001. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). in 1988. 10.1177/00912700222011157. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Provided by the Springer Nature SharedIt content-sharing initiative. [2]Before triggering seizures, the tumor presents with other symptoms: Sleep disturbances (Insomnia) The relationship of DNT to the epileptogenic foci can be determined by extensive interictal and ictal EEG recordings. The seizures started at the age of 11, and were of the complex partial atonic type. Neuroradiology, the requisites. 2015 Jan;157(1):63-75. doi: 10.1007/s00701-014-2217-3. After 14 years of evolution, our patient died suddenly during sleep. Clinical characteristics of patients with periictal cardiac abnormalities are very similar to those at greatest risk of SUDEP. It is true that a morphopathological examination would have helped to confirm the diagnosis, although this may sometimes be irrelevant. Defined as "a usually supratentorial glial-neuronal neoplasm occurring in children and young adults and characterized by a predominantly cortical location and by drug .