Diffusion tensor imaging changes in patients with glioma-associated seizures

Abstract

Introduction Structural white matter changes associated with certain epilepsy subtypes have been demonstrated using diffusion tensor imaging (DTI). This observational study aims to identify potential water diffusion abnormalities in glioma patients with associated seizures. Methods Two cohorts from two centers were analyzed independently: (A) Prospectively recruited patients diagnosed with glioma who received preoperative DTI to measure mean diffusivity (MD) and fractional anisotropy (FA) in regions-of-interest (ROIs) including the marginal tumor zone (TU), adjacent peritumoral white matter as well as distant ipsilateral and contralateral white matter and cortex. Data were compared between patients with and without seizures and tested for statistical significance. (B) A retrospective cohort using an alternative technical approach sampling ROIs in contrast enhancement, necrosis, non-enhancing tumor, marginal non-enhancing tumor zone, peritumoral tissue, edema and non-tumorous tissue. Results (A) The prospective study cohort consisted of 23 patients with 12 (52.2%) presenting with a history of seizures. There were no significant seizure-associated differences in MD or FA for non-tumor white matter or cortical areas. MD-TU was significantly lower in patients with seizures (p = 0.005). (B) In the retrospective cohort consisting of 46 patients with a seizure incidence of 50.0%, significantly decreased normalized values of MD were observed for non-enhancing tumor regions of non-glioblastoma multiforme (GBM) cases in patients with seizures (p = 0.022). Conclusion DTI analyses in glioma patients demonstrated seizure-associated diffusion restrictions in certain tumor-related areas. No other structural abnormalities in adjacent or distant white matter or cortical regions were detected.

Prevalence and risk factors of early postoperative seizures in patients with glioma: a systematic review and meta-analysis

“…Vasogenic brain edema increases capillary permeability and broken blood–brain barrier, leading to an abnormal distribution of ions inside and outside the cells, which in turn stimulates nerves and triggers seizures ( 38 ). In addition, when astrocytes are involved in cytotoxic brain edema due to increased occupancy effects, their ability to take up glutamate is reduced, which in turn affects the stability of the nerve cell membrane, inducing neuroexcitability and ultimately leading to seizures ( 39 ). This study also found that intratumoral hemorrhage is an independent risk factor for gliomas complicated by seizures.…”