Seizure characteristics and outcomes in 508 Chinese adult patients undergoing primary resection of low-grade gliomas: a clinicopathological study

Abstract

Seizure is a common presenting manifestation and plays an important role in the clinical presentation and quality of life for patients with low-grade gliomas (LGGs). The authors set out to identify factors that influence preoperative seizure characteristics and postoperative seizure control. Cases involving adult patients who had undergone initial surgery for LGGs in a single institution between 2005 and 2009 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to identify factors associated with preoperative seizures and postoperative seizure control. Of the 508 patients in the series, 350 (68.9%) presented with seizures. Age less than 38 years and cortical involvement of tumor were more likely to be associated with seizures (P = .003 and .001, respectively, multivariate logistic analysis). For the cohort of 350 patients with seizures, Engel classification was used to evaluate 6- and 12-month outcome after surgery: completely seizure free (Engel class I), 65.3% and 62.5%; not seizure free (Engel classes II, III, IV), 34.7% and 37.5%. After multivariate logistic analysis, favorable seizure prognosis was more common in patients with secondary generalized seizure (P = .006) and with calcification on MRI (.031). With respect to treatment-related variables, patients achieved much better seizure control after gross total resection than after subtotal resection (P < .0001). Ki67 was an independent molecular marker predicting poor seizure control in the patients with a history of seizure if overexpressed but was not a predictor for those without preoperative seizures. These factors may provide insight into developing effective treatment strategies aimed at prolonging patients' survival.

Seizure control after subtotal lesional resection

“…Rep resentative results are summarized in Table 1. Many large studies of low-grade gliomas have been accumulated; 5,6,9,26,37,38 only 1 has specifically focused on high-grade glioma. 7 Glioneuronal tumors, specifically ganglioglioma and DNET, are often considered together 3,18 because of their overlapping clinical and pathological characteristics, including epileptogenicity.…”

Predicting the Likelihood of Postoperative Seizure Status based on mRNA Sequencing in Low-Grade Gliomas

“…Although several factors are known to influence the likelihood of postoperative seizures, including WHO grade, gross total resection and Ki67 expression level [3], to date, we fail to find any mRNA-seq-based prediction model for postoperative seizures in glioma. In this study, we developed a statistical model that can accurately predict the likelihood of postoperative seizures, which may help patients with postoperative seizure control.…”

“…This indicates that the variability of seizure occurrence cannot be explained solely by peritumoral factors or histology, urging us to explore the genetic factors that may be associated with tumor-related seizure. The pathogenesis of tumor-related epilepsy seems to be different from that of idiopathic epilepsy, leading to distinct clinical characteristics and treatment [3].…”

“…This indicates that the variability of seizure occurrence cannot be explained solely by peritumoral factors or histology, urging us to explore the genetic factors that may be associated with tumor-related seizure. The pathogenesis of tumor-related epilepsy seems to be different from that of idiopathic epilepsy, leading to distinct clinical characteristics and treatment [3].Seizure, as one of the most common postoperative symptom in patients with LGGs [4][5][6][7], when uncontrolled, would badly affect patients' quality of life (QOL), causing cognitive deterioration and may result in significant morbidity [8][9][10][11]. Postoperatively uncontrolled seizures and subsequent use of anti-epileptic drugs (AEDs) would continuously affect QOL and cognitive function [8,10].…”

“…Postoperatively uncontrolled seizures and subsequent use of anti-epileptic drugs (AEDs) would continuously affect QOL and cognitive function [8,10]. Although two-thirds of patients with LGGs would experience seizures after surgery [3], not all LGGs are associated with postoperative seizures, despite of similar histology and tumor location. Therefore, predicting postoperative seizure in patients with diffuse LGGs is valuable [12].…”