Epilepsy in cerebral glioma: timing of appearance and histological correlations

Abstract

Our study clearly shows that epilepsy is more frequent in low-grade gliomas but seizures are more difficult to control in high-grade gliomas. In both cases seizures are a quite exclusive symptom at the onset that never appears during the stable course of the disease. Amongst glioblastoma multiforme (GBM), epilepsy is more frequent in GBM developing through progression from low-grade astrocitoma. Moreover, our study strongly indicates that the prophylactic use of AEDs in glioma is not justified.

Different Aquaporin-4 Expression in Glioblastoma Multiforme Patients with and without Seizures

“…The pathogenesis of the seizures in these patients is unknown but is likely imputable to a number of different factors (16). These include alterations in extracellular pH, bleeding and modified synthesis and catabolism of neurotransmitters (2,16,17). Cortical location of GBM is a risk factor for seizures.…”

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

“…From the reverse perspective, somewhere between 10 and 50% of brain tumours present with seizures as a symptom [69,74,[81][82][83], and sometimes as the only symptom [32,41,[84][85][86], with supratentorial and especially temporal lesions the most likely to be epileptogenic [44,66,78,[86][87][88]. In one study that compared children with supra-and infratentorial tumours, for example, among those with supratentorial lesions, 42% experienced vomiting as their first symptom, followed by seizures in 37%, and headache in 31% [43].…”

“…This practice of prescribing AEDs prophylactically in brain tumour patients with no seizure history persists, even though empirical evidence addressing this practice is inconclusive at best [78,81,127,140,172]. Moreover, many authors and the most current American Association of Neurology practice parameters argue against it [113,140,172,175,176].…”

“…What this suggests is that the aggressiveness of the tumour might have an effect upon seizure development. This being said, low-grade lesions comprise the majority of epileptogenic tumours, both in children and adults [78]; and some tumour types -like gangliogliomas and dysembryoplastic neuroepithelial tumours (DNET) -are more likely to induce seizures than others [28].…”

Unmet needs in the treatment of glioblastoma

“…Seizures may be the presenting symptom or develop during the course of the disease [67]. Although epilepsy was less frequent in high-grade glioma, in these patients, seizures were more difficult to control [68]. Neurosurgeons mostly use antiepileptic prophylaxis because intralesional bleeding, increase of edema and local electrolytic/pH changes may provoke seizure.…”