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Prevalence of seizures in brain tumor: A meta-analysis. Epilepsy Res 2022; 187:107033. [DOI: 10.1016/j.eplepsyres.2022.107033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
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2
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de Bruin ME, van der Meer PB, Dirven L, Taphoorn MJB, Koekkoek JAF. Efficacy of antiepileptic drugs in glioma patients with epilepsy: a systematic review. Neurooncol Pract 2021; 8:501-517. [PMID: 34589231 PMCID: PMC8475226 DOI: 10.1093/nop/npab030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Comprehensive data on the efficacy and tolerability of antiepileptic drugs (AED) treatment in glioma patients with epilepsy are currently lacking. In this systematic review, we specifically assessed the efficacy of AEDs in patients with a grade II-IV glioma. Methods Electronic databases PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched up to June 2020. Three different outcomes for both mono- and polytherapy were extracted from all eligible articles: (i) seizure freedom; (ii) ≥50% reduction in seizure frequency; and (iii) treatment failure. Weighted averages (WA) were calculated for outcomes at 6 and 12 months. Results A total of 66 studies were included. Regarding the individual outcomes on the efficacy of monotherapy, the highest seizure freedom rate at 6 months was with phenytoin (WA = 72%) while at 12-month pregabalin (WA = 75%) and levetiracetam (WA = 74%) showed highest efficacy. Concerning ≥50% seizure reduction rates, levetiracetam showed highest efficacy at 6 and 12 months (WAs of 82% and 97%, respectively). However, treatment failure rates at 12 months were highest for phenytoin (WA = 34%) and pregabalin (41%). When comparing the described polytherapy combinations with follow-up of ≥6 months, levetiracetam combined with phenytoin was most effective followed by levetiracetam combined with valproic acid. Conclusion Given the heterogeneous patient populations and the low scientific quality across the different studies, seizure rates need to be interpreted with caution. Based on the current limited evidence, with the ranking of AEDs being confined to the AEDs studied, levetiracetam, phenytoin, and pregabalin seem to be most effective as AED monotherapy in glioma patients with epilepsy, with levetiracetam showing the lowest treatment failure rate, compared to the other AEDs studied.
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Affiliation(s)
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Rades D, Witteler J, Olbrich D, Trillenberg P, Schild SE, Tvilsted S, Kjaer TW. A prospective interventional study evaluating seizure activity during a radiotherapy course for high-grade gliomas (SURF-ROGG). BMC Cancer 2021; 21:386. [PMID: 33836671 PMCID: PMC8033669 DOI: 10.1186/s12885-021-08121-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Gliomas are often associated with symptoms including seizures. Most patients with high-grade gliomas are treated with radiotherapy or radio-chemotherapy. Since irradiation causes inflammation, it may initially aggravate symptoms. Studies focusing on seizure activity during radiotherapy for gliomas are not available. Such knowledge may improve patient monitoring and anti-epileptic treatment. This study evaluates seizure activity during radiotherapy for high-grade gliomas. Methods The primary objective this prospective interventional study is the evaluation of seizure activity during a course of radiotherapy for high-grade gliomas. Progression of seizure activity is defined as increased frequency of seizures by > 50%, increased severity of seizures, or initiation/increase by ≥25% of anti-epileptic medication. Seizure frequency up to 6 weeks following radiotherapy and electroencephalography activity typical for epilepsy will also be evaluated. Patients keep a seizure diary during and up to 6 weeks following radiotherapy. Every day, they will document number (and type) of seizures and anti-epileptic medication. Once a week, the findings of the diary are checked and discussed with a neurologist to initiate or adjust anti-epileptic medication, if necessary. Patients complete a questionnaire regarding their satisfaction with the seizure diary. If the dissatisfaction rate is > 40%, the seizure diary will be considered not suitable for the investigated indication. Thirty-five patients (32 patients plus drop-outs) should be enrolled. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with progression of seizure activity is 30% (rate under the alternative hypothesis), assuming a ‘natural’ background progression-rate of 10% without radiotherapy (null hypothesis). Discussion If an increase in seizure activity during a course of radiotherapy for high-grade glioma occurs, the findings of this study may pave the way for a larger prospective trial and will likely lead to closer patient monitoring and better anti-epileptic treatment. Trial registration clinicaltrials.gov (NCT04552756); registered on 16th of September, 2020.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Jaspar Witteler
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | | | | | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Soeren Tvilsted
- Research Projects and Clinical Optimization, Zealand University Hospital, Koege, Denmark
| | - Troels W Kjaer
- Neurological Department, Zealand University Hospital, Roskilde, Denmark
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Thakkar JP, Prabhu VC, Rouse S, Lukas RV. Acute Neurological Complications of Brain Tumors and Immune Therapies, a Guideline for the Neuro-hospitalist. Curr Neurol Neurosci Rep 2020; 20:32. [PMID: 32596758 DOI: 10.1007/s11910-020-01056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Patients with brain tumors presenting to the emergency room with acute neurologic complications may warrant urgent investigations and emergent management. As the neuro-hospitalist will likely encounter this complex patient population, an understanding of the acute neurologic issues will have value. RECENT FINDINGS We discuss updated information and management regarding various acute neurologic complications among neuro-oncology patients and neurologic complications of immunotherapy. Understanding of the acute neurologic complications associated with central nervous system tumors and with common contemporary cancer treatments will facilitate the neuro-hospitalist management of these patient populations. While there are aspects analogous to the diagnosis and management in the non-oncologic population, a number of unique features discussed in this review should be considered.
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Affiliation(s)
- Jigisha P Thakkar
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Bldg 105, Room 2700, Maywood, IL, 60153, USA. .,Department of Neurosurgery, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Bldg 105, Room 1900, Maywood, IL, 60153, USA.
| | - Vikram C Prabhu
- Department of Neurosurgery, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Bldg 105, Room 1900, Maywood, IL, 60153, USA
| | - Stasia Rouse
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Bldg 105, Room 2700, Maywood, IL, 60153, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Abbott Hall 1114, Chicago, IL, 60611, USA.,Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, 60611, USA
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5
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Kalakoti P, Edwards A, Ferrier C, Sharma K, Huynh T, Ledbetter C, Gonzalez-Toledo E, Nanda A, Sun H. Biomarkers of Seizure Activity in Patients With Intracranial Metastases and Gliomas: A Wide Range Study of Correlated Regions of Interest. Front Neurol 2020; 11:444. [PMID: 32547475 PMCID: PMC7273506 DOI: 10.3389/fneur.2020.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/27/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Studies quantifying cortical metrics in brain tumor patients who present with seizures are limited. The current investigation assesses morphometric/volumetric differences across a wide range of anatomical regions, including temporal and extra-temporal, in patients with gliomas and intracranial metastases (IMs) presenting with seizures that could serve as a biomarker in the identification of seizure expression and serve as a neuronal target for mitigation. Methods: In a retrospective design, the MR sequences of ninety-two tumor patients [55% gliomas; 45% IM] and 34 controls were subjected to sophisticated morphometric and volumetric assessments using BrainSuite and MATLAB modules. We examined 103 regions of interests (ROIs) across eight distinct cortical categories of interests (COI) [gray matter, white matter; total volume, CSF; cortical areas: inner, mid, pial; cortical thickness]. The primary endpoint was quantifying and identifying ROIs with significant differences in z-scores based upon the presence of seizures. Feature selection employing neighborhood component analysis (NCA) determined the ROI within each COI having the highest significance/weight in the differentiation of seizure vs. non-seizure patients harboring brain tumor. Results: Overall, the mean age of the cohort was 58.0 ± 12.8 years, and 45% were women. The prevalence of seizures in tumor patients was 28%. Forty-two ROIs across the eight pre-defined COIs had significant differences in z-scores between tumor patients presenting with and without seizures. The NCA feature selection noted the volume of pars-orbitalis and right middle temporal gyrus to have the highest weight in differentiating tumor patients based on seizures for three distinct COIs [GM, total volume, and CSF volume] and white matter, respectively. Left-sided transverse temporal gyrus, left precuneus, left transverse temporal, and left supramarginal gyrus were associated with having the highest weight in the differentiation of seizure vs. non-seizure in tumor patients for morphometrics relating to cortical areas in the pial, inner and mid regions and cortical thickness, respectively. Conclusion: Our study elucidates potential biomarkers for seizure targeting in patients with gliomas and IMs based upon morphometric and volumetric assessments. Amongst the widespread brain regions examined in our cohort, pars orbitalis, supramarginal and temporal gyrus (middle, transverse), and the pre-cuneus contribute a maximal potential for differentiation of seizure patients from non-seizure.
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Affiliation(s)
- Piyush Kalakoti
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, United States
| | - Alicia Edwards
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, United States
| | - Christopher Ferrier
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, United States
| | - Kanika Sharma
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Trong Huynh
- Department of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
- Department of Neurosurgery, Rutgers University, Newark, NJ, United States
| | - Christina Ledbetter
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, United States
| | - Eduardo Gonzalez-Toledo
- Neuroradiology, Department of Radiology, Louisiana State University Health Science Center, Shreveport, LA, United States
| | - Anil Nanda
- Department of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
- Department of Neurosurgery, Rutgers University, Newark, NJ, United States
| | - Hai Sun
- Department of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
- Department of Neurosurgery, Rutgers University, Newark, NJ, United States
- *Correspondence: Hai Sun
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Elf K, Ronne-Engström E, Semnic R, Rostami-Berglund E, Sundblom J, Zetterling M. Continuous EEG monitoring after brain tumor surgery. Acta Neurochir (Wien) 2019; 161:1835-1843. [PMID: 31278599 PMCID: PMC6704081 DOI: 10.1007/s00701-019-03982-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Abstract
Background Prolonged seizures generate cerebral hypoxia and increased intracranial pressure, resulting in an increased risk of neurological deterioration, increased long-term morbidity, and shorter survival. Seizures should be recognized early and treated promptly. The aim of the study was to investigate the occurrence of postoperative seizures in patients undergoing craniotomy for primary brain tumors and to determine if non-convulsive seizures could explain some of the postoperative neurological deterioration that may occur after surgery. Methods A single-center prospective study of 100 patients with suspected glioma. Participants were studied with EEG and video recording for at least 24 h after surgery. Results Seven patients (7%) displayed seizure activity on EEG recording within 24 h after surgery and another two patients (2%) developed late seizures. One of the patients with early seizures also developed late seizures. In five patients (5%), there were non-convulsive seizures. Four of these patients had a combination of clinically overt and non-convulsive seizures and in one patient, all seizures were non-convulsive. The non-convulsive seizures accounted for the majority of total seizure time in those patients. Non-convulsive seizures could not explain six cases of unexpected postoperative neurological deterioration. Postoperative ischemic lesions were more common in patients with early postoperative seizures. Conclusions Early seizures, including non-convulsive, occurred in 7% of our patients. Within this group, non-convulsive seizure activity had longer durations than clinically overt seizures, but only 1% of patients had exclusively non-convulsive seizures. Seizures were not associated with unexpected neurological deterioration. Electronic supplementary material The online version of this article (10.1007/s00701-019-03982-6) contains supplementary material, which is available to authorized users.
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Zhang J, Yao L, Peng S, Fang Y, Tang R, Liu J. Correlation between glioma location and preoperative seizures: a systematic review and meta-analysis. Neurosurg Rev 2018; 42:603-618. [PMID: 30073426 DOI: 10.1007/s10143-018-1014-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 12/28/2022]
Abstract
Epilepsy is a common manifestation of glioma patients and negatively impacts on quality of life and neurocognitive function. The risk of preoperative seizures in patients with glioma is currently under discussion. We aimed to evaluate the relationship between tumor locations in the cerebrum and preoperative seizures in patients with glioma. PubMed, EMBASE, Web of Science, China Biology Medicine, and the Cochrane Library were systematically searched from inception to July 15, 2017, for original studies including reports of preoperative seizures in patients with gliomas in different brain regions. The pooled odds ratio (OR) and 95% confidence interval (CI) of the meta-analysis for preoperative seizure risk stratified by cerebrum regions were calculated. The quality of evidence was assessed per outcome, using the approach of the Grades of Recommendation, Assessment, Development and Evaluation. Overall, 4323 participants in 16 population-based studies were included in this meta-analysis. The meta-analysis indicated that gliomas in the frontal lobe (OR = 1.51, 95% CI = 1.09-2.09, P = 0.013) were associated with a higher risk for preoperative seizure compared to occipital lobe involved (OR = 0.53, 95% CI = 0.32-0.88, P = 0.014). Regarding the other three lobe involved gliomas, no difference was found between the incidence of preoperative seizures and tumor location. Current limited data suggest that frontal gliomas were associated with a higher risk of preoperative seizures, while gliomas in the occipital lobe were associated with a lower seizure risk. Further RCT studies recruiting larger sample sizes are required to validate these results and guide clinical practice.
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Affiliation(s)
- Jian Zhang
- Department of Neurology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Liang Yao
- Clinical Evidence Based Medicine Center, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Shaopeng Peng
- Department of Neurology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Yuan Fang
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Ruitian Tang
- School of Clinical Medical Sciences, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jianxiong Liu
- Department of Neurology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China.
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Dewan MC, White-Dzuro GA, Brinson PR, Zuckerman SL, Morone PJ, Thompson RC, Wellons JC, Chambless LB. The Influence of Perioperative Seizure Prophylaxis on Seizure Rate and Hospital Quality Metrics Following Glioma Resection. Neurosurgery 2017; 80:563-570. [PMID: 28362915 DOI: 10.1093/neuros/nyw106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiepileptic drugs (AEDs) are frequently administered prophylactically to mitigate seizures following craniotomy for brain tumor resection. However, conflicting evidence exists regarding the efficacy of AEDs, and their influence on surgery-related outcomes is limited. OBJECTIVE To evaluate the influence of perioperative AEDs on postoperative seizure rate and hospital-reported quality metrics. METHODS A retrospective cohort study was conducted, incorporating all adult patients who underwent craniotomy for glioma resection at our institution between 1999 and 2014. Patients in 2 cohorts-those receiving and those not receiving prophylactic AEDs-were compared on the incidence of postoperative seizures and several hospital quality metrics including length of stay, discharge status, and use of hospital resources. RESULTS Among 342 patients with glioma undergoing cytoreductive surgery, 301 (88%) received AED prophylaxis and 41 (12%) did not. Seventeen patients (5.6%) in the prophylaxis group developed a seizure within 14 days of surgery, compared with 1 (2.4%) in the standard group (OR = 2.2, 95% CI [0.3-17.4]). Median hospital and intensive care unit lengths of stay were similar between the cohorts. There was also no difference in the rate at which patients presented within 90 days postoperatively to the emergency department or required hospital readmission. In addition, the rate of hospital resource consumption, including electroencephalogram and computed tomography scan acquisition, and neurology consultation, was similar between both groups. CONCLUSION The administration of prophylactic AEDs following glioma surgery did not influence the rate of perioperative seizures, nor did it reduce healthcare resource consumption. The role of perioperative seizure prophylaxis should be closely reexamined, and reconsideration given to this commonplace practice.
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Di Bonaventura C, Albini M, D'Elia A, Fattouch J, Fanella M, Morano A, Lucignani G, Manfredi M, Colonnese C, Salvati M, Vanacore N, Berardelli A, Giallonardo AT. Epileptic seizures heralding a relapse in high grade gliomas. Seizure 2017; 51:157-162. [PMID: 28873363 DOI: 10.1016/j.seizure.2017.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/04/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Seizures are a common clinical symptom in high-grade gliomas (HGG). The aim of the study was to investigate the relationship between seizures and HGG relapse (HGG-R). METHODS We retrospectively evaluated 145 patients who were surgically treated for HGG-R. By analyzing clinical characteristics in these patients (all operated and treated by the same protocol), we identified 37 patients with seizures during follow-up. This cohort was divided into four subgroups according to a) presence or absence of seizures at the time of diagnosis and b) temporal relationship between seizure occurrence and HGG-R during follow-up: subgroup A (25pts) had seizures at follow-up but not at onset, subgroup B (12pts) had seizures both at follow-up and onset, subgroup C (30pts) had seizures before MRI-documented HGG-R, and subgroup D (7pts) had seizures after MRI-documented HGG-R. RESULTS Although the datum was not statistically significant, survival was longer in patients with seizures during follow-up than in those without seizures (59.3% vs 51.4% alive at 2 years). In 30 patients (subgroup C) seizures heralded HGG-R. In a correlation analysis for this last subgroup, the time interval between seizure and the HGG-R was significantly associated with the number of chemotherapy cycles (r=0.470; p=0.009) and follow-up duration (r=0.566; p=0.001). A linear regression model demonstrated a reciprocal association between the above factors and that it may be possible to estimate the timing of HGG-R by combining these data. CONCLUSIONS Seizures may herald HGG-R before MRI detection of relapse, thus suggesting that seizures should always be considered a red flag during follow-up.
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Affiliation(s)
| | - Mariarita Albini
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | | | - Jinane Fattouch
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Alessandra Morano
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Giulia Lucignani
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Claudio Colonnese
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy; IRCCS Neuromed, "Sapienza" University of Rome, Pozzilli, IS, Italy
| | - Maurizio Salvati
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Nicola Vanacore
- National Centre of Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy; IRCCS Neuromed, "Sapienza" University of Rome, Pozzilli, IS, Italy
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Eseonu CI, Eguia F, Garcia O, Kaplan PW, Quiñones-Hinojosa A. Comparative analysis of monotherapy versus duotherapy antiseizure drug management for postoperative seizure control in patients undergoing an awake craniotomy. J Neurosurg 2017. [PMID: 28621631 DOI: 10.3171/2017.1.jns162913] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postoperative seizures are a common complication in patients undergoing an awake craniotomy, given the cortical manipulation during tumor resection and the electrical cortical stimulation for brain mapping. However, little evidence exists about the efficacy of postoperative seizure prophylaxis. This study aims to determine the most appropriate antiseizure drug (ASD) management regimen following an awake craniotomy. METHODS The authors performed a retrospective analysis of data pertaining to patients who underwent an awake craniotomy for brain tumor from 2007 to 2015 performed by a single surgeon. Patients were divided into 2 groups, those who received a single ASD (the monotherapy group) and those who received 2 types of ASDs (the duotherapy group). Patient demographics, symptoms, tumor characteristics, hospitalization details, and seizure outcome were evaluated. Multivariable logistic regression was used to evaluate numerous clinical variables associated with postoperative seizures. RESULTS A total of 81 patients underwent an awake craniotomy for tumor resection of an eloquent brain lesion. Preoperative baseline characteristics were comparable between the 2 groups. The postoperative seizure rate was 21.7% in the monotherapy group and 5.7% in the duotherapy group (p = 0.044). Seizure outcome at 6 months' follow-up was assessed with the Engel classification scale. The duotherapy group had a significantly higher proportion of seizure-free (Engel Class I) patients than the monotherapy group (90% vs 60%, p = 0.027). The length of stay was similar, 4.02 days in the monotherapy group and 4.51 days in the duotherapy group (p = 0.193). The 90-day readmission rate was higher for the monotherapy group (26.1% vs 8.5% in the duotherapy group, p = 0.044). Multivariate logistic regression showed that preoperative seizure history was a significant predictor for postoperative seizures following an awake craniotomy (OR 2.08, 95% CI 0.56-0.90, p < 0.001). CONCLUSIONS Patients with a preoperative seizure history may be at a higher risk for postoperative seizures following an awake craniotomy and may benefit from better postoperative seizure control with postoperative ASD duotherapy.
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Affiliation(s)
- Chikezie I Eseonu
- 1Department of Neurological Surgery and Neuro-Oncology Outcomes Laboratory, Johns Hopkins University; and
| | - Francisco Eguia
- 1Department of Neurological Surgery and Neuro-Oncology Outcomes Laboratory, Johns Hopkins University; and
| | - Oscar Garcia
- 1Department of Neurological Surgery and Neuro-Oncology Outcomes Laboratory, Johns Hopkins University; and
| | - Peter W Kaplan
- 2Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alfredo Quiñones-Hinojosa
- 1Department of Neurological Surgery and Neuro-Oncology Outcomes Laboratory, Johns Hopkins University; and
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Huang C, Chi XS, Hu X, Chen N, Zhou Q, Zhou D, Li JM. Predictors and mechanisms of epilepsy occurrence in cerebral gliomas: What to look for in clinicopathology. Exp Mol Pathol 2017; 102:115-122. [PMID: 28087392 DOI: 10.1016/j.yexmp.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 02/05/2023]
Abstract
Gliomas, especially low-grade gliomas, are highly epileptogenic brain tumors. Histopathological information is valuable in evaluating the diagnosis and/or biologic behavior of various gliomas. Here we explored the clinical data and histopathological predictors of the occurrence of epilepsy in patients with gliomas. A retrospective study examined 310 consecutive patients who had undergone surgical treatment for gliomas in our institution from January 2013 to January 2015. Clinical data and pathological examination results were analyzed. Literatures regarding the predictors and etiology of glioma associated epileptic seizures in the period of 1995-2015 were also reviewed. A total of 234 (75.5%) astrocytic tumors and 76 (24.5%) oligodendrial tumors were included. At diagnosis, 33.6% of patients had epileptic seizures. Multivariate analysis revealed cortex involvement (OR=7.991, 95%CI=1.599-39.926), lower World Health Organization grade (OR=3.584, 95%CI=1.032-12.346) and topoisomerase II (TopoII) positivity (OR=0.943, 95%CI=0.903-0.982) were strong predictors for preoperative epileptic seizures. Gender, disease course, tumor classification, location or volume did not significantly affect epileptic seizure occurrence. Forty-three publications involved glioma-associated epilepsy were found in PubMed online database and key data were extracted and summarized. The present studies on glioma-related epilepsy are relatively limited and inconsistent. Low-grade gliomas, cortex involvement and TopoII positivity were independent predictors of a history of epileptic seizures at diagnosis. Further studies to examine the underlying mechanism of topoisomerase II as well as other molecules in epilepsy occurrence in brain gliomas are needed in the future.
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Affiliation(s)
- Cheng Huang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China; Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Xiao-Sa Chi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Qiao Zhou
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jin-Mei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China.
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12
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Incidental diffuse low-grade gliomas: from early detection to preventive neuro-oncological surgery. Neurosurg Rev 2015; 39:377-84. [DOI: 10.1007/s10143-015-0675-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/05/2015] [Accepted: 08/09/2015] [Indexed: 10/22/2022]
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de Oliveira Lima GL, Duffau H. Is there a risk of seizures in “preventive” awake surgery for incidental diffuse low-grade gliomas? J Neurosurg 2015; 122:1397-405. [DOI: 10.3171/2014.9.jns141396] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECT
Although a large amount of data supports resection for symptomatic diffuse low-grade glioma (LGG), the therapeutic strategy regarding incidental LGG (ILGG) is still a matter of debate. Indeed, early “preventive” surgery has recently been proposed in asymptomatic patients with LGG, after showing that the extent of resection was larger than in symptomatic patients with LGG. However, the quality of life should be preserved by avoiding both neurological deficit and epilepsy. The aim of this study was to determine the risk of seizures related to such a prophylactic surgical treatment in ILGG.
METHODS
The authors report a prospective series of 21 patients with ILGG who underwent awake surgery with a minimum follow-up of 20 months following resection. Data regarding clinicoradiological features, surgical procedures, and outcomes were collected and analyzed. In particular, the eventual occurrence and type of seizures in the intra- and postoperative periods were studied, as follows: early (< 3 months) and long-term (until last follow-up) periods.
RESULTS
There were no intraoperative seizures in this series. During the early postoperative period, the authors observed only a single episode of partial seizures in a patient with no antiepileptic drug (AED) prophylaxis—all other patients were given antiepileptic treatment following resection. The AEDs were discontinued in all cases, with a mean delay of 8 months after surgery (range 3–24 months). No patient had permanent neurological deficits. All 21 patients returned to an active familial, social, and professional life (working full time in all cases). Total or even “supratotal” resection (the latter meaning that a margin around the tumor visible on FLAIR-weighted MRI was removed) was achieved in 14 cases (67%). In 7 patients (33%) subtotal resection was performed, with a mean residual tumor volume of 1.5 ml (range 1–7 ml). No oncological treatment was administered in the postsurgical period. The mean follow-up after surgery was 49 months (range 20–181 months). Only 2 patients had seizures during the long-term follow-up. Indeed, due to tumor progression after incomplete resection, seizures occurred in 2 cases, 39 and 78 months postsurgery, leading to administration of AEDs and adjuvant treatment. So far, all patients are still alive and enjoy a normal life.
CONCLUSIONS
The risk of inducing seizures is very low in ILGG, and it does not represent an argument against early surgery. These data strongly support the proposal of a screening policy for LGG that will evolve toward a preventive treatment in a more systematic manner.
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Affiliation(s)
- Guilherme Lucas de Oliveira Lima
- 1Department of Neurosurgery, Onofre Lopes University Hospital, Rio Grande do Norte Federal University, Petrópolis, and
- 2Neurosurgical Section, Hospital do Coração de Natal, Lagoa Nova, Natal/RN Brazil
| | - Hugues Duffau
- 3Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center; and
- 4Institute for Neuroscience of Montpellier, INSERM U1051, Team “Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors,” Saint Eloi Hospital, Montpellier University MedicalCenter, Montpellier, France
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Bauer R, Ortler M, Seiz-Rosenhagen M, Maier R, Anton JV, Unterberger I. Treatment of epileptic seizures in brain tumors: a critical review. Neurosurg Rev 2014; 37:381-8; discussion 388. [PMID: 24760366 DOI: 10.1007/s10143-014-0538-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 10/24/2013] [Accepted: 01/26/2014] [Indexed: 01/28/2023]
Abstract
Epileptic seizures represent a common signal of intracranial tumors, frequently the presenting symptom and the main factor influencing quality of life. Treatment of tumors concentrates on survival; antiepileptic drug (AED) treatment frequently is prescribed in a stereotyped way. A differentiated approach according to epileptic syndromes can improve seizure control and minimize unwarranted AED effects. Prophylactic use of AEDs is to be discouraged in patients without seizures. Acutely provoked seizures do not need long-term medication except for patients with high recurrence risk indicated by distinct EEG patterns, auras, and several other parameters. With chronically repeated seizures (epilepsies), long-term AED treatment is indicated. Non-enzyme-inducing AEDs might be preferred. Valproic acid exerts effects against progression of gliomatous tumors. In low-grade astrocytomas with epilepsy, a comprehensive presurgical epilepsy work-up including EEG-video monitoring is advisable; in static non-progressive tumors, it is mandatory. In these cases, the neurosurgical approach has to include the removal of the seizure-onset zone frequently located outside the lesion.
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Affiliation(s)
- R Bauer
- Neurosurgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria,
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15
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Gokhale S, Khan SA, Agrawal A, Friedman AH, McDonagh DL. Levetiracetam seizure prophylaxis in craniotomy patients at high risk for postoperative seizures. Asian J Neurosurg 2014; 8:169-73. [PMID: 24550999 PMCID: PMC3912766 DOI: 10.4103/1793-5482.125658] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: The risk of developing immediate postoperative seizures in patients undergoing supratentorial brain tumor surgery without anti-epileptic drug (AED) prophylaxis is 15-20%. Patients who present with pre-operative seizures and patients with supratentorial meningioma or supratentorial low grade gliomas are at significantly higher risk. There is little data on the efficacy of levetiracetam as a prophylactic AED in the immediate postoperative period (within 7 days of surgery) in these patients. Methods: We conducted a retrospective chart review of 165 adult patients classified as higher risk for postoperative seizures who underwent brain tumor resection at Duke University Hospital between time May 2010 and December 2011. All patients had received levetiracetam monotherapy in doses of 1000-3000 mg/day in the immediate postoperative period. Results: We identified 165 patients with following tumor locations: Frontal 83 (50.3%), Temporal 37 (22.4%), Parietal 30 (18.2%), Occipital 2 (1.2%) and 13 (7.8%) with single lesions involving more than one lobe. Histology revealed: Glioma 98 (59.4%), Meningioma 57 (34.5%) and Brain Metastases 6 (3.6%). Preoperatively, 88/165 (53.3%) patients had presented with seizures. 12/165 patients (7.3%) developed clinical seizures (generalized 10, partial 2) in the immediate post-operative period. Other than somnolence in 7 patients (4.2%), no major side-effects were noted. Conclusions: The incidence of seizures was significantly lower in patients treated with levetiracetam (7.3%) when compared with the expected (15-20%) rate without AED prophylaxis based on the previous literature. Levetiracetam appears effective and safe for seizure prevention in patients undergoing brain tumor resection and who are at significantly higher risk of developing post-operative seizures. These findings warrant confirmation in a prospective randomized trial.
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Affiliation(s)
- Sankalp Gokhale
- Department of Neurology, Division of Neurocritical Care, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - Shariq Ali Khan
- Department of Anesthesiology Division of Neuro-Anesthesia, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - Abhishek Agrawal
- Division of Neurosurgery, Department of Surgery and Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - Allan H Friedman
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - David L McDonagh
- Departments of Anesthesiology and Neurology, Division of Neuro-Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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16
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Seizures during the management of high-grade gliomas: clinical relevance to disease progression. J Neurooncol 2013; 113:101-9. [PMID: 23459994 DOI: 10.1007/s11060-013-1094-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 02/20/2013] [Indexed: 12/15/2022]
Abstract
This study was performed to evaluate the incidence of seizures with its implications on disease progression and the diagnostic value of post-ictal magnetic resonance images (MRI) during the management of high-grade gliomas (HGGs). A total of 406 consecutive patients with newly diagnosed HGGs were retrospectively reviewed. The incidence of seizures during the management was investigated. In patients who experienced a seizure, the causality between seizures and disease progression was assessed by pre-ictal, post-ictal (<1 month), and follow-up (<3 months) MRI. After a median follow-up of 17.4 months (range 0.1-88.3), seizures developed in 127 patients (31 %). Of the 127 patients, radiological progression at the post-ictal MRI was found in 83 patients (65 %) and the follow-up MRI confirmed progression in 79 patients (62 %). Four other patients (3 %) were shown to be progression-free. Among those without radiological progression at the post-ictal MRI, the follow-up MRI confirmed progression-free in 31 patients (24 %); however, 13 patients (10 %) revealed eventual progression. In the patients with a seizure, absence of preoperative seizures (p = 0.003), <95 % tumor resection (p = 0.001), and pre-ictal Karnofsky Performance Scale score ≤ 70 (p = 0.025) were significantly associated with disease progression. During the management of HGG, 31 % of patients experienced seizures; of these patients, 72 % harbored progressive disease. The post-ictal MRI is useful for detecting disease progression; however, there are pitfalls. Clinical settings should be considered together for diagnosing disease progression in patients with seizures.
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17
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Ojemann JG, Hersonskey TY, Abeshaus S, Geyer JR, Saneto RP, Novotny EJ, Kollros P, Leary S, Holmes MD. Epilepsy surgery after treatment of pediatric malignant brain tumors. Seizure 2012; 21:624-30. [PMID: 22835666 DOI: 10.1016/j.seizure.2012.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 11/28/2022] Open
Abstract
Epilepsy surgery is common in the face of benign brain tumors, but rarely for patients with a history of malignant brain tumors. Seizures are a common sequelae in survivors of malignant pediatric brain tumors. Medical management alone may not adequately treat epilepsy, including in this group. We report four cases of patients who previously underwent gross total resection, radiation therapy, and chemotherapy for successful treatment of malignant brain neoplasia, yet suffered from medically intractable seizures. All underwent surgery for treatment of epilepsy with extension of the original resection. Despite the aggressive primary treatment of the neoplasm, and the potential for diffuse cerebral insults, all benefited from focal surgical resection. Aggressive surgical management of intractable epilepsy can be considered in survivors of malignant brain tumors.
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Smits A, Duffau H. Seizures and the natural history of World Health Organization Grade II gliomas: a review. Neurosurgery 2012; 68:1326-33. [PMID: 21307795 DOI: 10.1227/neu.0b013e31820c3419] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The majority of adults with low-grade gliomas have seizures. Despite the frequency of seizures as initial symptoms and symptoms of later disease, seizures in relation to the natural course of low-grade gliomas have received little attention. METHODS In this review, we provide an update of the literature on the prognostic impact of preoperative seizures and discuss the tumor- and treatment-related factors affecting seizure control at later stages of the disease. RESULTS Seizures occur most frequently at disease presentation and predict a more favorable outcome. Initial seizures are correlated with tumor location and possibly indirectly to the molecular profile of the tumor. About 50% of all patients with seizures at presentation continue to have seizures before surgery. Maximal tumor resection, including resection of epileptic foci, is a valuable strategy for improving seizure control. In addition, radiotherapy and chemotherapy, as single therapies or in combination with surgery, have shown beneficial effects in terms of seizure reduction. Recurrent seizures after macroscopically complete tumor resection may be a marker for accelerated tumor growth. Recurrent seizures after an initial transient stabilization after radiotherapy and/or chemotherapy may be a marker for anaplastic tumor transformation. CONCLUSION Preoperative seizures likely reflect, apart from tumor location, intrinsic tumor properties as well. Change in seizure control in individual patients is frequently associated with altered tumor behavior. Including seizures and seizure control as clinical parameters is recommended in future trials of low-grade gliomas to further establish the prognostic value of these symptoms and to identify the factors affecting seizure control.
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Affiliation(s)
- Anja Smits
- Department of Neuroscience and Neurology, Uppsala University, University Hospital, Uppsala, Sweden.
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19
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Bähr O, Hermisson M, Rona S, Rieger J, Nussbaum S, Körtvelyessy P, Franz K, Tatagiba M, Seifert V, Weller M, Steinbach JP. Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial. Acta Neurochir (Wien) 2012; 154:229-35; discussion 235. [PMID: 21909835 DOI: 10.1007/s00701-011-1144-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/23/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Levetiracetam (LEV) is a newer anticonvulsant with a favorable safety profile. There seem to be no relevant drug interactions, and an intravenous formulation is available. Therefore, LEV might be a suitable drug for the perioperative anticonvulsive therapy of patients with suspected brain tumors undergoing neurosurgery. METHODS In this prospective study (NCT00571155) patients with suspected primary brain tumors and tumor-related seizures were perioperatively treated with oral and intravenous LEV up to 4 weeks before and until 4 weeks after a planned neurosurgical procedure. FINDINGS Thirty patients with brain tumor-related seizures and intended neurosurgery were included. Three patients did not undergo the scheduled surgery after enrollment, and two patients were lost to follow-up. Therefore, 25 patients were fully evaluable. After initiation of therapy with LEV, 100% of the patients were seizure-free in the pre-surgery phase (3 days up to 4 weeks before surgery), 88% in the 48 h post-surgery phase and 84% in the early follow-up phase (48 h to 4 weeks post surgery). Treatment failure even after dose escalation to 3,000 mg/day occurred in three patients. No serious adverse events related to the treatment with LEV occurred. CONCLUSION Our data show the feasibility and safety of oral and intravenous LEV in the perioperative treatment of tumor-related seizures. Although this was a single arm study, the efficacy of LEV appears promising. Considering the side effects and interactions of other anticonvulsants, LEV seems to be a favorable option in the perioperative treatment of brain tumor-related seizures.
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Affiliation(s)
- Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, Johann Wolfgang Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt, Germany.
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20
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Rheims S, Ricard D, van den Bent M, Taillandier L, Bourg V, Désestret V, Cartalat-Carel S, Hermier M, Monjour A, Delattre JY, Sanson M, Honnorat J, Ducray F. Peri-ictal pseudoprogression in patients with brain tumor. Neuro Oncol 2011; 13:775-82. [PMID: 21727213 DOI: 10.1093/neuonc/nor082] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recent advances in the treatment of malignant gliomas have highlighted the fact that the appearance of new contrast-enhancing lesions on magnetic resonance imaging (MRI) is not always indicative of tumor recurrence. It has been suggested that transient seizure-related MRI changes could mimic disease progression (peri-ictal pseudoprogression [PIPG]). However, the clinical and MRI features associated with this situation have not been well described. Here, we consulted the databases of 6 institutions to identify patients with brain tumor who presented during the follow-up period transient MRI lesions wrongly suggesting tumor progression in a context of epileptic seizures. Ten patients were identified. All patients but 1 were long-term survivors who had initially been treated with radiotherapy. The PIPG episode occurred after a median interval of 11 years after radiotherapy. MRI features were highly similar across patients and consisted of transient focal cortical and/or leptomeningeal enhancing lesions that erroneously suggested tumor progression. All patients improved after adjustment of their antiepileptic drugs and transient oral corticosteroids, and MRI findings were normalized 3 months after the PIPG episode. Two patients demonstrated several seizure relapses with the same clinicoradiological pattern. After a median follow-up period of 3.5 years after the initial PIPG episode, only 1 patient presented with a tumor recurrence. In conclusion, in patients with brain tumor, especially in long-term survivors of radiotherapy, the appearance of new cortical and/or leptomeningeal contrast-enhancing lesions in a context of frequent seizures should raise the suspicion of PIPG. This phenomenon is important to recognize in order to avoid futile therapeutic escalation.
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Affiliation(s)
- Sylvain Rheims
- Service de Neuro-Oncologie, Hospices Civils de Lyon, 59 boulevard Pinel, 69003 Lyon, France
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21
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22
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Reif PS, Strzelczyk A, Rüegg S, Jacobs AH, Haag A, Hermsen A, Sure U, Knake S, Hamer HM, Strik H, Krämer G, Engenhart-Cabilic R, Rosenow F. [Primary brain tumors and brain metastases. Symptomatic epilepsy and driving ability - systematic review and expert opinion]. DER NERVENARZT 2011; 81:1467-75. [PMID: 20495775 DOI: 10.1007/s00115-010-3011-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Primary brain tumors and metastases are common causes of symptomatic epilepsy. Seizures, neurological and neuropsychological deficits can interfere with driving ability. The present paper aims to systematically review the incidence of epileptic seizures in brain tumor patients and to discuss driving ability in the context of the current German guidelines and expert opinions. METHODS To evaluate the incidence of epileptic seizures which occur at the beginning and in the course of the disease, we performed a systematic literature research in PubMed from 1960 to 2007. Additionally on the basis of this data we performed a survey collecting expert opinions regarding the driving ability of brain tumor patients from members of the German working groups "Arbeitsgemeinschaft für prächirurgische Epilepsiediagnostik und operative Epilepsietherapie" (Working Group for Presurgical Epilepsy Diagnostics and Operative Epileptic Therapy) and "Neuroonkologische Arbeitsgemeinschaft" (Neuro-oncological Working Group). RESULTS The incidence of epileptic seizures depends on the entity, dignity and localization of the tumor. The driving ability of brain tumor patients is not explicitly regulated in Germany. Of the interviewed experts 72% judged the guidelines to be precise enough and 44% did not want to deprive the patients of their driving ability without a first seizure, independent of the individual risk. DISCUSSION The available studies are methodologically insufficient and show that a further evaluation is necessary to assess the driving ability. Possible restrictions of the driving ability in patients with a high risk of seizures in the course of the disease have to take into account the balance between individual rights and the interests of the general public.
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Affiliation(s)
- P S Reif
- Epilepsiezentrum Marburg, Klinik für Neurologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg
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23
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Lee JW, Wen PY, Hurwitz S, Black P, Kesari S, Drappatz J, Golby AJ, Wells WM, Warfield SK, Kikinis R, Bromfield EB. Morphological characteristics of brain tumors causing seizures. ACTA ACUST UNITED AC 2010; 67:336-42. [PMID: 20212231 DOI: 10.1001/archneurol.2010.2] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To quantify size and localization differences between tumors presenting with seizures vs nonseizure neurological symptoms. DESIGN Retrospective imaging survey. We performed magnetic resonance imaging-based morphometric analysis and nonparametric mapping in patients with brain tumors. SETTING University-affiliated teaching hospital. PATIENTS OR OTHER PARTICIPANTS One hundred twenty-four patients with newly diagnosed supratentorial glial tumors. MAIN OUTCOME MEASURES Volumetric and mapping methods were used to evaluate differences in size and location of the tumors in patients who presented with seizures as compared with patients who presented with other symptoms. RESULTS In high-grade gliomas, tumors presenting with seizures were smaller than tumors presenting with other neurological symptoms, whereas in low-grade gliomas, tumors presenting with seizures were larger. Tumor location maps revealed that in high-grade gliomas, deep-seated tumors in the pericallosal regions were more likely to present with nonseizure neurological symptoms. In low-grade gliomas, tumors of the temporal lobe as well as the insular region were more likely to present with seizures. CONCLUSIONS The influence of size and location of the tumors on their propensity to cause seizures varies with the grade of the tumor. In high-grade gliomas, rapidly growing tumors, particularly those situated in deeper structures, present with non-seizure-related symptoms. In low-grade gliomas, lesions in the temporal lobe or the insula grow large without other symptoms and eventually cause seizures. Quantitative image analysis allows for the mapping of regions in each group that are more or less susceptible to seizures.
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Affiliation(s)
- Jong Woo Lee
- Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Kurzwelly D, Herrlinger U, Simon M. Seizures in patients with low-grade gliomas--incidence, pathogenesis, surgical management, and pharmacotherapy. Adv Tech Stand Neurosurg 2010; 35:81-111. [PMID: 20102112 DOI: 10.1007/978-3-211-99481-8_4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Seizures complicate the clinical course of > 80% of patients with low-grade gliomas. Patients with some tumor variants almost always have epilepsy. Diffuse low-grade gliomas (LGG) are believed to cause epilepsy through partial deafferentiation of nearby brain cortex (denervation hypersensitivity). Glioneural tumors may interfere with local neurotransmitter levels and are sometimes associated with structural abnormalities of the brain which may produce seizures. The severity of tumor associated epilepsy varies considerably between patients. Some cases may present with a first seizure. Others suffer from long-standing pharmacoresistant epilepsy. Seizure control rates of > 70-80% can be expected after complete tumor resections. Patients with drug-resistant epilepsy require a comprehensive preoperative epileptological work-up which may include the placement of subdural (and intraparenchymal) electrodes or intraoperative electrocorticography (ECoG) for the delineation of extratumoral seizure foci. Partial and subtotal tumor resections are helpful in selected cases, i.e. for gliomas involving the insula. In one series, 40% of patients presented for surgery with uncontrolled seizures, i.e. medical therapy alone often fails to control tumor-related epilepsy. Use of the newer (second generation) non-enzyme inducing antiepileptic drugs (non-EIAED) is encouraged since they seem to have lesser interactions with other medications (e.g. chemotherapy). Chemotherapy and irradiation may have some minor beneficial effects on the patients' seizure disorder. Overall 60-70% of patients may experience recurrent epilepsy during long-term follow-up. Recurrent seizures (not infrequently heralding tumor recurrence) after surgery continue to pose significant clinical problems.
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Affiliation(s)
- D Kurzwelly
- Schwerpunkt Klinische Neuroonkologie, Neurologische Klinik, Universitätskliniken Bonn, Bonn, Germany
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25
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Maschio M, Dinapoli L, Zarabla A, Pompili A, Carapella CM, Pace A, Giannarelli D, Occhipinti E, Jandolo B. Outcome and tolerability of topiramate in brain tumor associated epilepsy. J Neurooncol 2007; 86:61-70. [PMID: 17598071 DOI: 10.1007/s11060-007-9430-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 05/31/2007] [Indexed: 10/23/2022]
Abstract
Epilepsy in brain tumor patients is often refractory to pharmacological treatments and can complicate the therapeutic management of these patients. We conducted a prospective, observational study. The aim of this study was to investigate the efficacy and tolerability of topiramate (TPM) in brain tumor associated epilepsy. We studied 47 patients with brain tumors and epilepsy. The entire group was administered AEDs. TPM was the first therapeutic choice in 14 patients, while in the remaining 33 patients previous AEDs were modified and TPM was introduced due to side effects or inefficacy of the first drug. Follow-up ranged from 3 to 48 months (mean 16.5 months). Considering the final follow-up of each patient who assumed TPM for at least 3 months, we observed 45 patients: 25 were seizure free (55.6%), 9 had a reduction of seizure frequency (SF) higher than 50% (20%) and 11 were stable (24.4%). TPM responder rate was 75.6%. Three patients (6.4%) discontinued TPM for severe side effects (1 after 4 months and 2 after 1 month) and 4 (8.5%) had mild and reversible side effects. In the group of patients who had been in therapy with other AEDs prior to entering the study (n = 33), 19 patients had side effects (57.6%). During follow-up, the haematological parameters were in the normative ranges. Tumor-related seizures are difficult to control with AEDs; the precise reasons for this difficulty are not yet clear. Using TPM, we obtained good seizure control with a low incidence of side effects.
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Affiliation(s)
- M Maschio
- Epilepsy Outpatient Center, Department of Neuroscience and Cervical-Facial Pathology, National Institute for Cancer Regina Elena, Via Elio Chianesi 53, Roma, 00144, Italy.
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26
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Stevens GHJ. Antiepileptic therapy in patients with central nervous system malignancies. Curr Neurol Neurosci Rep 2006; 6:311-8. [PMID: 16822352 DOI: 10.1007/s11910-006-0024-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
More than 200,000 patients are diagnosed with primary or metastatic brain tumors each year in the United States. Of these patients, 20% to 40% will develop seizures at presentation, and another 20% to 40% will require treatment for seizures during their illness. Although the use of antiepileptic drugs (AEDs) in patients who have had seizures seems reasonable, the issue of prophylactic AED use for patients who have not had a seizure is an intensely debated subject. The American Academy of Neurology released a position statement in May 2000 addressing the use of anticonvulsants in newly diagnosed brain tumor patients who have never had a seizure. After a review of the literature, including all trials showing class I evidence, multivariate analysis using calculated odds ratios failed to show a prophylactic benefit of preventing a first seizure versus the risk of side effects and recommended not using prophylactic anticonvulsants in newly diagnosed patients with brain tumor. Despite this recommendation, a recent survey of the American Association of Neurologic Surgeons revealed that most neurosurgeons still use anticonvulsants prophylactically in patients with brain tumor. This review mainly includes primary brain tumors, but most of the concepts are transferable to patients with metastatic tumors.
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Affiliation(s)
- Glen H J Stevens
- Brain Tumor Institute, Taussig Cancer Center-R20, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Wick W, Menn O, Meisner C, Steinbach J, Hermisson M, Tatagiba M, Weller M. Pharmacotherapy of Epileptic Seizures in Glioma Patients: Who, When, Why and How Long? Oncol Res Treat 2005; 28:391-6. [PMID: 16160401 DOI: 10.1159/000086375] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The risk for patients with primary brain tumors of experiencing an epileptic seizure at least once in the course of disease probably exceeds 50%, depending on tumor location and tumor type. Several aspects regarding the role of anticonvulsants in the treatment of brain tumor patients have remained controversial. PATIENTS AND METHODS We reviewed the seizure history in 107 patients undergoing a surgical procedure for glioma at our institution. RESULTS The overall seizure incidence was 68%. Pre-operative seizures did not predict the occurrence of post-operative seizures. After surgery, postoperative chemo- or radiotherapy and anticonvulsive therapy one third of patients was seizure-free whereas one third showed frequent seizures despite this treatment. Seizure frequency increased regardless of anticonvulsive treatment with progressive or recurrent tumor growth. CONCLUSIONS Based on a literature review and our institutional experience, we delineate some recommendations for the management of seizures in patients with brain tumors.
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Affiliation(s)
- Wolfgang Wick
- Abteilung für Allgemeine Neurologie, Hertie-Institut für Klinische Hirnforschung, Zentrum für Neurologie, Universitatsklinikum Tübingen, Germany.
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