Presurgical cognitive status in patients with low‐grade glioma and epilepsy: Testing the effects of seizures, antiseizure medications, and tumor localization

Abstract

Background: Low-grade gliomas (LGGs) are frequently associated with epilepsy. There are few studies addressing the impact of seizures, antiseizure medications (ASMs), and lesion localization on presurgery cognitive functioning. Methods:We tested the relation between the above-mentioned variables in a continuous series of 73 young patients (mean age 38.3 years ± 11.7) affected by LGGs and epilepsy. The anatomical areas, involved in this sample, were the left insula with surrounding cortical and subcortical areas, the right precentral gyrus/rolandic operculum, and the white matter and cortical regions beneath.Results: Patients' presurgery cognitive status was within the normal range, with borderline performance for some tasks. We tested whether lower scores were related with lesion or with epilepsy-related factors. Multiple regression identified variables that predict test scores. The Token test score was predicted by a model (p = .0078) containing the DT2T1 MRI, corrected for seizure features. Object naming performance was predicted by a model (p = .0113) containing the localization, the DT2T1 MRI, corrected for sex, EEG, and onset. Verbal fluency score was predicted by a model (p = .0056) containing the localization and the DT2T1 MRI, corrected for AEDs and EEG. Working memory score was predicted by a model (p = .0117) containing Engel class, the DT2T1 MRI, corrected for sex. Clock drawing score was predicted by a model (p < .0001) containing the Engel class, AEDs, and EEG. TMT A score was predicted by a model (p = .0022) containing localization, corrected for EEG. TMT B-A score was predicted by a model (p = .0373) containing localization. Voxel Lesion Symptom Mapping analyses carried out on patients' lesion volumes confirmed that patients' level of performance correlated with lesion-related variables. Conclusion:This preliminary study indicates that the presurgical level of performance for language tasks and for cognitive flexibility and shifting is mainly predicted by lesion-related variables, working memory by both lesion and epilepsy-relatedThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

What is the cognitive footprint of insular glioma?

“…Tumor volume was associated with effect on preoperative cognitive function in patients with LGG, including insula, as quantified by standard MRI sequences and voxel-based lesion symptom mapping (VLSM) The study consisted of 8 patients with dominant hemisphere insular glioma, and they demonstrated significantly poor performance in object naming. Additionally, VLSM revealed that for both left and right hemispheric glioma groups, 36% of patients with working memory (verbal and visual) impairment had insular involvement ( Guarracino et al, 2022 ).…”