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Ghane N, Khalili S, Khorasani SN, Das O, Ramakrishna S, Neisiany RE. Antiepileptic drug-loaded and multifunctional iron oxide@silica@gelatin nanoparticles for acid-triggered drug delivery. Sci Rep 2024; 14:11400. [PMID: 38762571 PMCID: PMC11102556 DOI: 10.1038/s41598-024-62248-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/15/2024] [Indexed: 05/20/2024] Open
Abstract
The current study developed an innovative design for the production of smart multifunctional core-double shell superparamagnetic nanoparticles (NPs) with a focus on the development of a pH-responsive drug delivery system tailored for the controlled release of Phenytoin, accompanied by real-time monitoring capabilities. In this regard, the ultra-small superparamagnetic iron oxide@silica NPs (IO@Si MNPs) were synthesized and then coated with a layer of gelatin containing Phenytoin as an antiepileptic drug. The precise saturation magnetization value for the resultant NPs was established at 26 emu g-1. The polymeric shell showed a pH-sensitive behavior with the capacity to regulate the release of encapsulated drug under neutral pH conditions, simultaneously, releasing more amount of the drug in a simulated tumorous-epileptic acidic condition. The NPs showed an average size of 41.04 nm, which is in the desired size range facilitating entry through the blood-brain barrier. The values of drug loading and encapsulation efficiency were determined to be 2.01 and 10.05%, respectively. Moreover, kinetic studies revealed a Fickian diffusion process of Phenytoin release, and diffusional exponent values based on the Korsmeyer-Peppas equation were achieved at pH 7.4 and pH 6.3. The synthesized NPs did not show any cytotoxicity. Consequently, this new design offers a faster release of PHT at the site of a tumor in response to a change in pH, which is essential to prevent epileptic attacks.
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Affiliation(s)
- Nazanin Ghane
- Department of Chemical Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Shahla Khalili
- Department of Chemical Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Saied Nouri Khorasani
- Department of Chemical Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Oisik Das
- Department of Civil, Environmental and Natural Resources Engineering, Luleå University of Technology, 97187, Luleå, Sweden.
| | - Seeram Ramakrishna
- Center for Nanotechnology & Sustainability, National University of Singapore, Singapore, 117574, Singapore
| | - Rasoul Esmaeely Neisiany
- Department of Polymer Engineering, Hakim Sabzevari University, Sabzevar, 9617976487, Iran.
- Biotechnology Centre, Silesian University of Technology, Krzywoustego 8, 44-100, Gliwice, Poland.
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Feigl GC, Staribacher D, Britz G, Kuzmin D. Minimally Invasive Approaches in the Surgical Treatment of Intracranial Meningiomas: An Analysis of 54 Cases. Brain Tumor Res Treat 2024; 12:93-99. [PMID: 38742257 PMCID: PMC11096627 DOI: 10.14791/btrt.2024.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Intracranial meningiomas, being a fairly common disease in the population, often require surgical treatment, which, in turn, can completely heal the patient. The localization of meningiomas often influences treatment even if they are asymptomatic. By modernizing approaches to surgical treatment, it is possible to minimize intra- and postoperative risks, while achieving complete removal of the tumor. One of these methods is minimally invasive neurosurgery, the development of which in recent years allows it to compete with standard surgical methods. The purpose of this study was the objectification of minimally invasive approaches, such as the calculation of the craniotomy area and the ratio of craniotomy area to the resected tumor volume. METHODS The retrospective study consisted of a group of 54 consecutive patients who were operated on in our neurosurgery clinic specialized on minimally invasive neurosurgery. Preoperative planning was carried out using the Surgical Theater visualization platform. Using this system, the tumor volume and craniotomy surface area were calculated. During the analysis, the symptoms before and after the surgery, classification of tumors, postoperative complications, further treatment and follow-up results were assessed. RESULTS Twelve (22.2%) patients were men and 42 (77.8%) were women. The mean age of the group was 64.2 years (median 67.5). The craniotomy area ranged from 202 to 2,108 mm² (mean 631 mm²). Tumor volume ranged from 0.85 to 110.1 cm3 (mean 21.6 cm3). The craniotomy size of minimally invasive approaches to the skull base was 3-5 times smaller than standard approaches. Skull base meningiomas accounted for 19 cases (35.2%), convexity meningiomas for 26 cases (48.1%), and falx and tentorium meningiomas for 9 cases (16.7%). Three complications were reported: postoperative hemorrhage, CSF leakage, and ophthalmoplegia. Relapse was detected in 2 patients with a mean follow-up of 26.3 months (median 20). CONCLUSION Minimally invasive approaches in the surgical treatment of intracranial meningiomas reduce the possibility of operating trauma by several times; they are safe and sufficient for complete removal of the tumor.
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Affiliation(s)
- Guenther C Feigl
- General Hospital Bamberg, Bamberg, Germany
- University Hospital Tuebingen, Tuebingen, Germany
- Houston Methodist Hospital, Houston, Texas, USA.
| | | | - Gavin Britz
- Houston Methodist Hospital, Houston, Texas, USA
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Goertz L, Bernards N, Muders H, Hamisch C, Goldbrunner R, Krischek B. Incidence and Clinical Presentation of Pre- and Postoperative Seizures in Patients With Posterior Fossa Meningiomas. Cureus 2024; 16:e52474. [PMID: 38371129 PMCID: PMC10873762 DOI: 10.7759/cureus.52474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Seizures are a common symptom of supratentorial meningiomas with pre- and postoperative seizure rates of approximately 30% and 12%, respectively, especially in parasagittal and convexity meningiomas. Less is known about the association between seizures and posterior fossa meningiomas. This study evaluates the prevalence, potential causes, and outcomes of seizures in patients who have undergone surgery for posterior fossa meningioma. METHODS This is a retrospective, observational, single-center study of consecutive patients who underwent surgical resection of posterior fossa meningiomas between 2009 and 2017. We retrospectively identified patients with seizures and analyzed patient demographics, tumor characteristics, and procedural characteristics. RESULTS A total of 44 patients (mean age: 59.8 ± 13.5 years) were included. Twenty-six tumors were located at the cerebellar convexity and tentorium (59.1%), 12 at the cerebellopontine angle (27.3%), four at the clivus (9.1%), and two at the foramen magnum (4.5%). Seizures were the presenting symptom of cerebellar meningioma in two patients. Patients were seizure-free after surgery. Three patients had their first seizure after surgery (interval between surgery and first seizure: two days to 17 months). Analysis of these three patients revealed possible causes of postoperative seizures: radiation necrosis and edema, hyponatremia, and preoperative hydrocephalus. In all patients with postoperative seizures, long-term seizure control was achieved with the administration of antiepileptic drugs. CONCLUSIONS The incidence of seizures in patients with posterior fossa meningiomas is relatively low. Antiepileptic drugs can help to achieve seizure control.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Nora Bernards
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Hannah Muders
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Christina Hamisch
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Roland Goldbrunner
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Boris Krischek
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
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Joghataei MT, Bakhtiarzadeh F, Dehghan S, Ketabforoush AHME, Golab F, Zarbakhsh S, Ahmadirad N. The role of neurotransmitters in glioblastoma multiforme-associated seizures. Int J Dev Neurosci 2023; 83:677-690. [PMID: 37563091 DOI: 10.1002/jdn.10294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
GBM, or glioblastoma multiforme, is a brain tumor that poses a great threat to both children and adults, being the primary cause of death related to brain tumors. GBM is often associated with epilepsy, which can be debilitating. Seizures and the development of epilepsy are the primary symptoms that have a severe impact on the quality of life for GBM patients. It is increasingly apparent that the nervous system plays an essential role in the tumor microenvironment for all cancer types, including GBM. In recent years, there has been a growing understanding of how neurotransmitters control the progression of gliomas. Evidence suggests that neurotransmitters and neuromodulators found in the tumor microenvironment play crucial roles in the excitability, proliferation, quiescence, and differentiation of neurons, glial cells, and neural stem cells. The involvement of neurotransmitters appears to play a significant role in various stages of GBM. In this review, the focus is on presenting updated knowledge and emerging ideas regarding the interplay between neurotransmitters and neuromodulators, such as glutamate, GABA, norepinephrine, dopamine, serotonin, adenosine, and their relationship with GBM and the seizures induced by this condition. The review aims to explore the current understanding and provide new insights into the complex interactions between these neurotransmitters and neuromodulators in the context of GBM-related seizures.
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Affiliation(s)
| | - Fatemeh Bakhtiarzadeh
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Samaneh Dehghan
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fereshteh Golab
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sam Zarbakhsh
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Nooshin Ahmadirad
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
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McAfee D, Moyer M, Queen J, Mortazavi A, Boddeti U, Bachani M, Zaghloul K, Ksendzovsky A. Differential metabolic alterations in IDH1 mutant vs. wildtype glioma cells promote epileptogenesis through distinctive mechanisms. Front Cell Neurosci 2023; 17:1288918. [PMID: 38026690 PMCID: PMC10680369 DOI: 10.3389/fncel.2023.1288918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Glioma-related epilepsy (GRE) is a hallmark clinical presentation of gliomas with significant impacts on patient quality of life. The current standard of care for seizure management is comprised of anti-seizure medications (ASMs) and surgical resection. Seizures in glioma patients are often drug-resistant and can often recur after surgery despite total tumor resection. Therefore, current research is focused on the pro-epileptic pathological changes occurring in tumor cells and the peritumoral environment. One important contribution to seizures in GRE patients is metabolic reprogramming in tumor and surrounding cells. This is most evident by the significantly heightened seizure rate in patients with isocitrate dehydrogenase mutated (IDHmut) tumors compared to patients with IDH wildtype (IDHwt) gliomas. To gain further insight into glioma metabolism in epileptogenesis, this review compares the metabolic changes inherent to IDHmut vs. IDHwt tumors and describes the pro-epileptic effects these changes have on both the tumor cells and the peritumoral environment. Understanding alterations in glioma metabolism can help to uncover novel therapeutic interventions for seizure management in GRE patients.
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Affiliation(s)
- Darrian McAfee
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mitchell Moyer
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jaden Queen
- The College of Arts and Sciences, Cornell University, Ithaca, NY, United States
| | - Armin Mortazavi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Ujwal Boddeti
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Muzna Bachani
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
| | - Alexander Ksendzovsky
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
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Singh G, Kumar Verma P, Kumar Srivastava A, Kanti Das K, Mehrotra A, Dikshit P, Kumar A, Kanjilal S, Prakash Maurya V, Singh Bhaisora K, Singh S, Jaiswal S, Kumar Jaiswal A, Mishra P, Behari S, Kumar R. Factors predicting seizure outcome after surgical excision of meningioma: SOLID-C guideline for prophylactic AED. J Clin Neurosci 2023; 117:143-150. [PMID: 37804675 DOI: 10.1016/j.jocn.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Seizures are commonly seen among meningioma patients and may cause impaired quality of life. These patients can be effectively treated with surgery. Still, many patients have persistent seizure episodes after surgery. The factors which are associated with worsening of seizure episodes remain critical in improving the quality of life for such patients. In this study, we aim to analyze the clinical and histopathological factors to predict the post excision seizure-outcome in meningioma and need of antiepileptic prophylaxis for these patients. METHODS Adult patients who underwent primary resection of meningioma at our institute between 2007 and 2020 were included in the study. Eligibility criteria were as follows: (i) Surgery for newly-diagnosed biopsy proven meningioma, (ii) Presence of pre-operative seizure (iii) A follow-up period ≥ 12 months. RESULTS Of the 1145 patients in this series, 333 patients were recruited in study. The major determinants of prophylactic anti-epileptic were tumour size (S), Oedema (O), location (L), inclusion body (I), antiepileptic drugs (D) and surgical complication (C). The factors independently associated with poor seizure control after surgical resection were presence of brain parenchyma invasion (p < 0.001), pre-operative use of > 2 antiepileptics (p = 0.016) and presence of intranuclear inclusion bodies (p = 0.001). CONCLUSIONS The identification and consideration of factors associated with prolonged seizure control after surgery may help us to guide treatment strategies aimed at improving the quality of life for patients with meningiomas. Authors have proposed a SOLID-C guideline to avoid the blanket approach of prophylactic AED in patients undergoing for meningioma resection.
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Affiliation(s)
- Guramritpal Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Suyash Singh
- Department of Neurosurgery, AIIMS Raebareli, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Zhang J, Gong L, Zhu H, Sun W, Tian J, Zhang Y, Liu Q, Li X, Zhang F, Wang S, Zhu S, Ding D, Zhang W, Yang C. RICH2 decreases the mitochondrial number and affects mitochondrial localization in diffuse low-grade glioma-related epilepsy. Neurobiol Dis 2023; 188:106344. [PMID: 37926169 DOI: 10.1016/j.nbd.2023.106344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023] Open
Abstract
Epilepsy, a common complication of diffuse low-grade gliomas (DLGGs; diffuse oligodendroglioma and astrocytoma collectively), severely compromises the quality of life of patients. DLGG epileptogenicity may primarily be generated by interactions between the tumor and the neocortex. Neuronal uptake of dysfunctional mitochondria from the extracellular environment can lead to abnormal neuronal discharge. Mitochondrial dysfunction is frequently observed in gliomas that can transmigrate across the plasma membranes. Here, we examined the role of the Rho GTPase-activating protein 44 (RICH2) in mitochondrial dynamics and DLGG-related epilepsy. We investigated the association between mitochondrial and RICH2 expression in human DLGG tissues using immunohistochemistry. We examined the association between RICH2 and epilepsy in nude mouse glioma models by electrophysiology. The effect of RICH2 on mitochondrial morphology and calcium motility were assessed by single cell fluorescence microscopy. Quantitative RT-PCR (qRT-PCR) and Western blot analysis were performed to characterize RICH2 induced expression changes in the genes related to mitochondrial dynamics, mitogenesis and mitochondrial function. We found that RICH2 expression was higher in oligodendroglioma than in astrocytoma and was correlated with better prognosis and higher epilepsy rate in patients. The expression of mitochondria may be associated with clinical DLGG-related epilepsy and reduced by RICH2 overexpression. And RICH2 could promote DLGG-related epilepsy in tumorigenic nude mice. RICH2 overexpression decreased calcium flow and the mitochondria released from glioma cells (SW1088 and U251) into the extracellular environment, potentially via downregulation of MFN-1/MFN-2 levels which suggests reduced mitochondrial fusion. In addition, we observed decreased mitochondrial trafficking into neurons (released from glioma cells and trafficked into neurons), which could explain the higher incidence of DLGG-related epilepsy due to reduced neuroprotection. Furthermore, RICH2 downregulated MAPK/ERK/HIF-1 pathway. In conclusion, these results suggest that RICH2 could promote epilepsy by (i) inhibiting mitochondrial fusion via MFN downregulation and Drp-1 upregulation; (ii) altering the MAPK/ERK/Hif-1 signaling axis. RICH2 may be a potential target in the treatment of DLGG-related epilepsy.
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Affiliation(s)
- Jiarui Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China; Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Li Gong
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Huayu Zhu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Sun
- Institute for Biomedical Sciences of Pain, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Tian
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yan Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Qiao Liu
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaolan Li
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Fuqin Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shumei Wang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shaojun Zhu
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Dongjing Ding
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| | - Chen Yang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
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Bonosi L, Benigno UE, Musso S, Giardina K, Gerardi RM, Brunasso L, Costanzo R, Paolini F, Buscemi F, Avallone C, Gulino V, Iacopino DG, Maugeri R. The Role of Aquaporins in Epileptogenesis-A Systematic Review. Int J Mol Sci 2023; 24:11923. [PMID: 37569297 PMCID: PMC10418736 DOI: 10.3390/ijms241511923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Aquaporins (AQPs) are a family of membrane proteins involved in the transport of water and ions across cell membranes. AQPs have been shown to be implicated in various physiological and pathological processes in the brain, including water homeostasis, cell migration, and inflammation, among others. Epileptogenesis is a complex and multifactorial process that involves alterations in the structure and function of neuronal networks. Recent evidence suggests that AQPs may also play a role in the pathogenesis of epilepsy. In animal models of epilepsy, AQPs have been shown to be upregulated in regions of the brain that are involved in seizure generation, suggesting that they may contribute to the hyperexcitability of neuronal networks. Moreover, genetic studies have identified mutations in AQP genes associated with an increased risk of developing epilepsy. Our review aims to investigate the role of AQPs in epilepsy and seizure onset from a pathophysiological point of view, pointing out the potential molecular mechanism and their clinical implications.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (U.E.B.); (S.M.); (K.G.); (R.M.G.); (L.B.); (R.C.); (F.P.); (F.B.); (C.A.); (V.G.); (D.G.I.)
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Kumar K, Dubey V, Zaidi SS, Tripathi M, Siraj F, Sharma MC, Chandra PS, Doddamani R, Dixit AB, Banerjee J. RNA Sequencing of Intraoperative Peritumoral Tissues Reveals Potential Pathways Involved in Glioma-Related Seizures. J Mol Neurosci 2023; 73:437-447. [PMID: 37268865 DOI: 10.1007/s12031-023-02125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
Tumor-induced changes in the peritumoral neocortex play a crucial role in generation of seizures. This study aimed to investigate the molecular mechanisms potentially involved in peritumoral epilepsy in low-grade gliomas (LGGs). Intraoperative peritumoral brain tissues resected from LGG patients with seizures (pGRS) or without seizures (pGNS) were used for RNA sequencing (RNA-seq). Comparative transcriptomics was performed to identify differentially expressed genes (DEGs) in pGRS compared to pGNS using deseq2 and edgeR packages (R). Gene set enrichment analysis (GSEA) using Gene Ontology terms and Kyoto Encyclopedia of Genes & Genomes (KEGG) pathways was performed using the clusterProfiler package (R). The expression of key genes was validated at the transcript and protein levels in the peritumoral region using real-time PCR and immunohistochemistry, respectively. A total of 1073 DEGs were identified in pGRS compared to pGNS, of which 559 genes were upregulated and 514 genes were downregulated (log2 fold-change ≥ 2, padj < 0.001). The DEGs in pGRS were highly enriched in the "Glutamatergic Synapse" and "Spliceosome" pathways, with increased expression of GRIN2A (NR2A), GRIN2B (NR2B), GRIA1 (GLUR1), GRIA3 (GLUR3), GRM5, CACNA1C, CACNA1A, and ITPR2. Moreover, increased immunoreactivity was observed for NR2A, NR2B, and GLUR1 proteins in the peritumoral tissues of GRS. These findings suggest that altered glutamatergic signaling and perturbed Ca2+ homeostasis may be potential causes of peritumoral epilepsy in gliomas. This explorative study identifies important genes/pathways that merit further characterization for their potential involvement in glioma-related seizures.
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Affiliation(s)
| | - Vivek Dubey
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Syeda S Zaidi
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | | | - Fouzia Siraj
- ICMR-National Institute of Pathology, New Delhi, India
| | | | | | | | - Aparna Banerjee Dixit
- Dr. B.R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India.
| | - Jyotirmoy Banerjee
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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Peláez-Cruz R, Díaz-Baamonde A, Téllez MJ, Urriza J, Ghatan S, Ulkatan S. Unexpected median SEPs fluctuations during brain cavernous malformation resection with no post-operative deficit. J Clin Monit Comput 2023; 37:37-43. [PMID: 35357618 DOI: 10.1007/s10877-022-00852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/21/2022] [Indexed: 01/24/2023]
Abstract
Median nerve somatosensory evoked potentials (SEPs) may present changes during cavernous malformation (CM) resection unrelated to new post-operative sensory deficits. We performed intraoperative neurophysiological monitoring of median SEPs (m-SEPs) in three patients who underwent CM resection (surgery) near the sensory-motor cortex. The only preoperative clinical manifestations in all patients were seizures. All patients presented m-SEPs alterations on the side of the lesion during the procedure. Two patients presented permanent changes in the cortical potentials. In the third patient, the cortical and subcortical components suffered temporal fluctuations to return to baselines at the end of the surgery. None of these patients developed new post-operative clinical deficits. During brain cavernous malformation resection, significant fluctuations in the amplitude of different components of m-SEPs may occur. These changes may be due to excitability variations on m-SEP generators and do not translate into new post-operative neurological deficits.
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Affiliation(s)
- Roberto Peláez-Cruz
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA.
| | - Alba Díaz-Baamonde
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA
| | - Maria J Téllez
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA
| | - Javier Urriza
- Department of Clinical Neurophysiology, Complejo Hospitalario de Navarra, C/de Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Saadi Ghatan
- Department of Neurosurgery, Mount Sinai West and Mount Sinai Morningside, Pediatric Neurosurgery, Mount Sinai Health System, Mount Sinai West Hospital, 1000, 10th Avenue, New York, NY, USA
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA
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11
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He X, Zhang K, Liu D, Yang Z, Li X, Yang Z. Predictors of seizure outcomes in patients with diffuse low-grade glioma-related epilepsy after complete glioma removal. CNS Neurosci Ther 2022; 29:736-743. [PMID: 36514187 PMCID: PMC9873512 DOI: 10.1111/cns.14061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/11/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS We aimed to identify predictors of postoperative seizures in patients with diffuse low-grade glioma (DLGG)-related epilepsy after complete tumor resection in this study. METHODS We retrospectively collected data from individuals with DLGG-related epilepsy whose tumors were completely resected at Xiangya Hospital, Central South University between January 2014 and January 2020. The predictors of seizure outcomes were assessed by employing univariate analysis and a multivariate logistic regression model in a backward binary logistic regression model. RESULTS Among the 118 cases that met the inclusion criteria, 83.05% were seizure-free following an average follow-up of 4.27 ± 1.65 years, all of whom were classified as International League Against Epilepsy class I outcome. Univariate and multivariate analyses indicated that seizure duration of >6 years (odds ratio [OR], 6.62; 95% confidence interval [CI], 1.76-24.98; p = 0.005) and first clinical symptoms other than seizures (OR, 4.51; 95% CI, 1.43-14.23; p = 1.010) were both independent predictors of unfavorable seizure outcomes. CONCLUSION Our results imply that satisfactory seizure outcomes can be achieved in most patients with DLGG-related epilepsy after complete tumor resection. Patients with seizure duration of >6 years or first clinical symptoms other than seizures were more likely to experience postoperative seizure recurrence.
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Affiliation(s)
- Xinghui He
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Kai Zhang
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Xuejun Li
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
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12
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Sato Y, Tsuji Y, Yamazaki M, Fujii Y, Shirasawa A, Harada K, Mizutani T. Interictal High Gamma Oscillation Regularity as a Marker for Presurgical Epileptogenic Zone Localization. Oper Neurosurg (Hagerstown) 2022; 23:164-173. [PMID: 35486873 DOI: 10.1227/ons.0000000000000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/12/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To ensure that epilepsy surgery is effective, accurate presurgical localization of the epileptogenic zone is essential. Our previous reports demonstrated that interictal high gamma oscillation (30-70 Hz) regularity (GOR) on intracranial electroencephalograms is related to epileptogenicity. OBJECTIVE To examine whether preoperative GOR analysis with interictal high-density electroencephalography (HD-EEG) improves the accuracy of epileptogenic focus localization and enhances postoperative seizure control. METHODS We calculated GOR from 20 seconds of HD-EEG data for 21 patients with refractory focal epilepsy (4 with nonlesional temporal lobe epilepsy) scheduled for epilepsy surgery. Low-resolution brain electromagnetic tomography was used to analyze the high GOR source. To validate our findings, we made comparisons with other conventional localization methods and postoperative seizure outcomes. RESULTS In all patients, the areas of interictal high GOR were identified and resected. All patients were seizure-free after the operation. The concordance between the results of interictal high GOR on HD-EEG and those of source estimation of interictal discharge was fully overlapping in 10 cases, partially overlapping in 8 cases, and discordant in 3 cases. The concordance between the results of interictal high GOR on HD-EEG and those of interictal 123 I-iomazenil single-photon emission computed tomography was fully overlapping in 8 cases, partially overlapping in 11 cases, and discordant in 2 cases. In 4 patients with nonlesional temporal lobe epilepsy, the interictal high GOR on HD-EEG was useful in confirming the epileptogenic zone. CONCLUSION The interictal high GOR on HD-EEG is an excellent marker for presurgical epileptogenic zone localization.
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Affiliation(s)
- Yosuke Sato
- Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
| | - Yoshihito Tsuji
- Department of Neurosurgery, Matsubara Tokushukai Hospital, Osaka, Japan
| | | | | | | | | | - Tohru Mizutani
- Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
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13
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Silva M, Vivancos C, Duffau H. The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude. Brain Sci 2022; 12:brainsci12040504. [PMID: 35448035 PMCID: PMC9032126 DOI: 10.3390/brainsci12040504] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/22/2022] Open
Abstract
Diffuse low-grade gliomas (DLGGs) are heterogeneous and poorly circumscribed neoplasms with isolated tumor cells that extend beyond the margins of the lesion depicted on MRI. Efforts to demarcate the glioma core from the surrounding healthy brain led us to define an intermediate region, the so-called peritumoral zone (PTZ). Although most studies about PTZ have been conducted on high-grade gliomas, the purpose here is to review the cellular, metabolic, and radiological characteristics of PTZ in the specific context of DLGG. A better delineation of PTZ, in which glioma cells and neural tissue strongly interact, may open new therapeutic avenues to optimize both functional and oncological results. First, a connectome-based “supratotal” surgical resection (i.e., with the removal of PTZ in addition to the tumor core) resulted in prolonged survival by limiting the risk of malignant transformation, while improving the quality of life, thanks to a better control of seizures. Second, the timing and order of (neo)adjuvant medical treatments can be modulated according to the pattern of peritumoral infiltration. Third, the development of new drugs specifically targeting the PTZ could be considered from an oncological (such as immunotherapy) and epileptological perspective. Further multimodal investigations of PTZ are needed to maximize long-term outcomes in DLGG patients.
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Affiliation(s)
- Melissa Silva
- Department of Neurosurgery, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
| | - Catalina Vivancos
- Department of Neurosurgery, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors”, Institute of Functional Genomics, National Institute for Health and Medical Research (INSERM) U1191, University of Montpellier, 34295 Montpellier, France
- Correspondence:
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14
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Mader MMD, Deuter D, Sauvigny T, Borchert P, Faizy TD, Bester M, Westphal M, Rosengarth K, Schmidt NO, Sedlacik J, Dührsen L. Diffusion tensor imaging changes in patients with glioma-associated seizures. J Neurooncol 2022; 160:311-320. [PMID: 36344852 PMCID: PMC9722813 DOI: 10.1007/s11060-022-04139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022]
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.
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Affiliation(s)
- Marius Marc-Daniel Mader
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, 265 Campus Drive, Stanford, CA 94305 USA
| | - Daniel Deuter
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Patrick Borchert
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Tobias D. Faizy
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,Department of Neuroimaging and Neurointervention, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305 USA
| | - Maxim Bester
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Katharina Rosengarth
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Nils O. Schmidt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Jan Sedlacik
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,Centre for the Developing Brain and Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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15
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Seizures in patients with IDH-mutated lower grade gliomas. J Neurooncol 2022; 160:403-411. [PMID: 36258151 PMCID: PMC9722876 DOI: 10.1007/s11060-022-04158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Most patients with Lower Grade Gliomas (LGG) present with epileptic seizures. Since the advent of molecular diagnostics, more homogenous sub-entities have emerged, including the isocitrate dehydrogenase-mutated (IDH-mutated) astrocytomas and 1p19q-codeleted oligodendrogliomas. We aimed to describe the occurrence of seizures in patients with molecularly defined LGG pre- and postoperatively and to analyze factors affecting seizure status postoperatively. METHODS A population-based cohort of 130 adult patients with IDH-mutated WHO grade 2 or 3 astrocytomas and oligodendrogliomas was assessed pertaining to seizure burden before and after surgery. RESULTS Fifty-four (79.4%) patients with astrocytoma and 45 (72.6%) patients with oligodendroglioma had a history of seizures before surgery. At 12 months postoperatively, 51/67 (76.1%) patients with astrocytoma and 47/62 (75.8%) patients with oligodendrogliomas were seizure free. In a multivariable logistic regression analysis, lower extent of resection (EOR) (OR 0.98; 95% CI 0.97-1.00, p = 0.01) and insular tumor location (OR 5.02; 95% CI 1.01-24.87, p = 0.048) were associated with presence of seizures within 1 year postoperatively in the entire LGG cohort. In sub-entities, EOR was in a similar manner associated with seizures postoperatively in astrocytomas (OR 0.98; 95% CI 0.96-0.99, p < 0.01) but not in oligodendrogliomas (p = 0.34). CONCLUSION Our results are well in line with data published for non-molecularly defined LGG with a large proportion of patients being seizure free at 1 year postoperative. Better seizure outcome was observed with increased EOR in astrocytomas, but this association was absent in oligodendrogliomas.
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16
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Siddiqui A, McGregor AL, Wheless JW, Klimo P, Boop FA, Khan RB. Utility of Epilepsy Surgery in Survivors of Childhood Cancer. Neuropediatrics 2021; 52:480-483. [PMID: 33853165 DOI: 10.1055/s-0041-1728653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Resection of an epileptogenic focus improves seizure control in patients with drug-resistant epilepsy. There is little data available on usefulness of epilepsy surgery in childhood cancer survivors with drug-resistant epilepsy. To learn about seizure outcome after epilepsy surgery in childhood cancer survivors, we retrospectively reviewed charts of 42 children who were referred to an epilepsy center for surgical evaluation. Sixteen children (38%) were offered epilepsy surgery and 10 consented. Seizure outcome was classified based on International League Against Epilepsy outcome scale. All 10 children were having multiple seizures a month on therapeutic doses of three antiepilepsy drugs (AEDs). At a median follow-up of 5.6 years after epilepsy surgery, three children had class 1 outcome (no seizures), four had class 3 outcome (1-3 seizure days/year), and three had class 4 outcome (≥ 50% reduction in seizure frequency). One child was off AEDs, seven were on a single AED, and two were on three AEDs at their last follow-up. Epilepsy surgery had low morbidity and improved seizure control in childhood cancer survivors with drug-resistant epilepsy. Childhood cancer survivors with drug-resistant epilepsy should be referred to an epilepsy center for a higher level of care.
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Affiliation(s)
| | - Amy L McGregor
- Division of Pediatric Neurology, Le Bonheur Comprehensive Epilepsy Program, University of Tennessee, Memphis, Tennessee, United States
| | - James W Wheless
- Division of Pediatric Neurology, Le Bonheur Comprehensive Epilepsy Program, University of Tennessee, Memphis, Tennessee, United States
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Raja B Khan
- Division of Neurology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States
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17
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Correia CE, Umemura Y, Flynn JR, Reiner AS, Avila EK. Pharmacoresistant seizures and IDH mutation in low-grade gliomas. Neurooncol Adv 2021; 3:vdab146. [PMID: 34729486 PMCID: PMC8557671 DOI: 10.1093/noajnl/vdab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Many low-grade gliomas (LGG) harbor isocitrate dehydrogenase (IDH) mutations. Although IDH mutation is known to be epileptogenic, the rate of refractory seizures in LGG with IDH mutation vs wild-type had not been previously compared. We therefore compared seizure pharmacoresistance in IDH-mutated and wild-type LGGs. Methods Single-institution retrospective study of patients with histologic proven LGG, known IDH mutation status, seizures, and ≥2 neurology clinic encounters. Seizure history was followed until histological high-grade transformation or death. Seizures requiring ≥2 changes in anti-epileptic drugs were considered pharmacoresistant. Incidence rates of pharmacoresistant seizures were estimated using competing risks methodology. Results Of 135 patients, 25 patients (19%) had LGGs classified as IDH wild-type. Of those with IDH mutation, 104 (94.5%) were IDH1 R132H; only 6 were IDH2 R172K. 120 patients (89%) had tumor resection, and 14 (10%) had biopsy. Initial post-surgical management included observation (64%), concurrent chemoradiation (23%), chemotherapy alone (9%), and radiotherapy alone (4%). Seizures became pharmacoresistant in 24 IDH-mutated patients (22%) and in 3 IDH wild-type patients (12%). The 4-year cumulative incidence of intractable seizures was 17.6% (95% CI: 10.6%-25.9%) in IDH-mutated and 11% (95% CI: 1.3%-32.6%) in IDH wild-type LGG (Gray’s P-value = .26). Conclusions 22% of the IDH-mutated patients developed pharmacoresistant seizures, compared to 12% of the IDH wild-type tumors. The likelihood of developing pharmacoresistant seizures in patients with LGG-related epilepsy is independent to IDH mutation status, however, IDH-mutated tumors were approximately twice as likely to experience LGG-related pharmacoresistant seizures.
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Affiliation(s)
- Carlos Eduardo Correia
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yoshie Umemura
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessica R Flynn
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anne S Reiner
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edward K Avila
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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18
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Kuribara T, Akiyama Y, Mikami T, Kimura Y, Komatsu K, Enatsu R, Tokinaga Y, Mikuni N. Preoperative Prediction of Communication Difficulties during Awake Craniotomy in Glioma Patients: A Retrospective Evaluation of 136 Cases at a Single Institution. Neurol Med Chir (Tokyo) 2020; 61:21-32. [PMID: 33208581 PMCID: PMC7812311 DOI: 10.2176/nmc.oa.2020-0232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Awake craniotomy has been widely performed in patients with glioma in eloquent areas to minimize postoperative brain dysfunction. However, neurological examination in awake craniotomy is sometimes problematic due to communication difficulties during the intraoperative awake period. We evaluated preoperative predictors of these difficulties in awake craniotomy for patients with glioma. In all, 136 patients with glioma who underwent awake craniotomy at our institution between January 2012 and January 2020 were retrospectively evaluated. Patients were divided into two groups (appropriately awake group and inappropriately awake group) depending on their state during the intraoperative awake period, and the relationship between communication difficulties in awake craniotomy and both clinical and radiological characteristics were assessed. The appropriately awake group included 110 patients, and the inappropriately awake group included 26 patients. Reasons for inclusion in the inappropriately awake group were insufficient wakefulness in 15 patients, restless state in 6, and intraoperative seizures in 5. In multivariate analysis, the likelihood of being inappropriately awake was inversely correlated with preoperative seizures (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.06–0.89; p = 0.033) and positively correlated with left-sided lesions (OR, 7.31; 95% CI, 1.54–34.62; p = 0.012). Both lack of preoperative seizures and left-sided lesions were identified as risk factors for intraoperative difficulties in awake craniotomy for patients with glioma. Understanding these risk factors may lead to more appropriate determination of eligibility for awake craniotomy.
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Affiliation(s)
| | | | | | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University
| | | | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University
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19
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Li C, Chen H, Tan Q, Xie C, Zhan W, Sharma A, Sharma HS, Zhang Z. The therapeutic and neuroprotective effects of an antiepileptic drug valproic acid in glioma patients. PROGRESS IN BRAIN RESEARCH 2020; 258:369-379. [PMID: 33223038 DOI: 10.1016/bs.pbr.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Glioma is the most common primary malignant brain tumor in adults and the patients have poor prognosis despite treatment with surgery, radiotherapy and chemotherapy. The anti-epileptic drug, valproic acid (VPA) as a HDAC inhibitors is often used in glioma patients even if the patients don't have brain tumors associated epilepsy (BAE). Some previous studies have found that VPA not only has anti-epileptic effect, but also has anti-glioma growth effect through enhance radiotherapy sensitivity or other mechanism. Then VPA is reported to improve the survival of glioma patients receiving chemoradiation therapy. In addition, there are limited researches have shown that VPA has a neuroprotective effect in protect normal cells and tissues from the deleterious effects of treatment of glioma, especially radiotherapy. We'll give a brief overview of these effects of VPA in glioma patients.
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Affiliation(s)
- Cong Li
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huijing Chen
- Guangzhou Huashang Vocational College, Guangzhou, China
| | - Qijia Tan
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Caijun Xie
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wengang Zhan
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Zhiqiang Zhang
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Development of a Rat Model for Glioma-Related Epilepsy. Int J Mol Sci 2020; 21:ijms21196999. [PMID: 32977526 PMCID: PMC7582710 DOI: 10.3390/ijms21196999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Seizures are common in patients with high-grade gliomas (30–60%) and approximately 15–30% of glioblastoma (GB) patients develop drug-resistant epilepsy. Reliable animal models are needed to develop adequate treatments for glioma-related epilepsy. Therefore, fifteen rats were inoculated with F98 GB cells (GB group) and four rats with vehicle only (control group) in the right entorhinal cortex. MRI was performed to visualize tumor presence. A subset of seven GB and two control rats were implanted with recording electrodes to determine the occurrence of epileptic seizures with video-EEG recording over multiple days. In a subset of rats, tumor size and expression of tumor markers were investigated with histology or mRNA in situ hybridization. Tumors were visible on MRI six days post-inoculation. Time-dependent changes in tumor morphology and size were visible on MRI. Epileptic seizures were detected in all GB rats monitored with video-EEG. Twenty-one days after inoculation, rats were euthanized based on signs of discomfort and pain. This study describes, for the first time, reproducible tumor growth and spontaneous seizures upon inoculation of F98 cells in the rat entorhinal cortex. The development of this new model of GB-related epilepsy may be valuable to design new therapies against tumor growth and associated epileptic seizures.
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21
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Cai C, Zhu Z, Guo X, Guo X, Jiang H, Zheng Z, Zhang J, Shao A, Zhu J. Sylvian Fissure Meningiomas: Case Report and Literature Review. Front Oncol 2020; 10:427. [PMID: 32373509 PMCID: PMC7176925 DOI: 10.3389/fonc.2020.00427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
Meningiomas are primary intracranial tumors derived from arachnoid cap cells or meningothelial cells and usually display dural attachment. However, a small proportion of meningiomas that arise from the Sylvian fissure do not manifest dural attachment. Sylvian fissure meningiomas are relatively rare and have differential characteristics as compared with typical meningiomas. Herein, we reported a special case of atypical meningioma in the Sylvian fissure, that showed non-enhancement after contract management. The patient was a 30-year-old woman with a 2-year history of seizures. Preoperative computerized tomography and magnetic resonance imaging scans showed a calcific, non-enhancing lesion in the right insula lobe. The lesion was excised surgically for seizure control. Intraoperatively, the tumor was observed to be closely adhered to the middle cerebral artery (MCA), resulting in mild arterial damage. A case of Sylvian fissure meningioma was ultimately diagnosed by histopathological examination of the resected specimens. Sylvian fissure meningiomas are closely associated with the MCA and exhibit unusual imaging characteristics. Preoperative misdiagnosis may have serious adverse consequences and may result in incorrect surgery. To improve awareness of Sylvian fissure meningiomas on the differential diagnosis of Sylvian fissure lesions among clinicians, we present this report and briefly summarize previously reported cases to describe the clinical, pathological, radiological, and surgical features.
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Affiliation(s)
- Chengwei Cai
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhoule Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinxia Guo
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoming Guo
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjie Jiang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Zheng
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Junming Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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22
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Arakawa A, Mitsutake A, Hideyama T, Sato T, Katsumata J, Seki T, Maekawa R, Ohno M, Narita Y, Shiio Y. A central nervous system metastasis of melanoma with stroke-like onset of left-lower quadrantanopsia. J Gen Fam Med 2020; 21:77-79. [PMID: 32489760 PMCID: PMC7260162 DOI: 10.1002/jgf2.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/24/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022] Open
Abstract
"Stroke mimics" mean diseases presenting with acute neurological impairments that are taken for stroke. Discriminating them is crucial to avoid improper treatment or delayed correct treatment. We describe a 48-year-old woman presenting with a sudden onset of scintillating scotoma and left-lower quadrantanopsia. Hyperacute cerebral infarction was suspected. However, brain magnetic resonance imaging (MRI) revealed a mass at the cortico-medullary junction in the right occipital lobe. We diagnosed her as metastatic melanoma. We suspected that neurological deficits can be attributed to seizure, and therefore introduced levetiracetam. She showed neurological improvement immediately. Our case demonstrated the importance of considering brain tumor as a differential diagnosis in patients presenting with acute-onset neurological deficits. In addition to appropriate treatment of tumor, the use of newer antiepileptic drugs resulted in good neurological prognosis in metastatic brain tumors.
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Affiliation(s)
- Akira Arakawa
- Department of NeurologyTokyo Teishin HospitalTokyoJapan
| | | | | | - Tatsuya Sato
- Department of NeurologyTokyo Teishin HospitalTokyoJapan
| | | | - Tomonari Seki
- Department of NeurologyTokyo Teishin HospitalTokyoJapan
| | - Risa Maekawa
- Department of NeurologyTokyo Teishin HospitalTokyoJapan
| | - Makoto Ohno
- Department of Cerebrospinal OncologyNational Cancer Center HospitalTokyoJapan
| | - Yoshitaka Narita
- Department of Cerebrospinal OncologyNational Cancer Center HospitalTokyoJapan
| | - Yasushi Shiio
- Department of NeurologyTokyo Teishin HospitalTokyoJapan
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Monforte Monteiro SR, Rossmeisl JH, Russell J, Holmes MA, Wessmann A, Morris J, Dobson JM, Vanhaesebrouck AE. Effect of radiotherapy on freedom from seizures in dogs with brain tumors. J Vet Intern Med 2020; 34:821-827. [PMID: 32032456 PMCID: PMC7096644 DOI: 10.1111/jvim.15695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022] Open
Abstract
Background Seizures are a common presenting sign in dogs with brain tumors. Hypothesis/Objectives To investigate the effect of radiotherapy on freedom from brain tumor‐associated seizures and survival time in dogs. Animals Thirty‐two client‐owned dogs with brain tumor‐associated seizures; 18 received medical treatment and radiotherapy, 14 received medical treatment alone. Methods Multicenter retrospective study. Baseline characteristics (seizure semiology, magnetic resonance imaging [MRI] characteristics, and treatment) and duration of seizure freedom were recorded for the 2 treatment groups. Duration of seizure freedom between groups was compared (log‐rank test) using Cox's proportional hazard analysis, with baseline characteristics entered as covariates. Results The duration of seizure freedom and survival time were significantly longer in the radiotherapy group (P < .001), with a mean of 24 months (95% confidence interval [CI], 14.3‐33.8) versus 1.7 months in the control group (95% CI, 0.5‐2.9) and a mean of 34.6 months (95% CI: 25.2‐44.1) versus 6.2 months in the control group (95% CI, 2.6‐9.7) respectively. Baseline characteristics were not associated with duration of seizure freedom after the start of treatment. In the radiotherapy group, 5 dogs were euthanized during the study period because of causes other than seizures. In the control group, recurrence of seizures was observed before death in all dogs. Conclusions and Clinical Importance A longer period of seizure freedom and longer survival time was observed in dogs with brain tumors after radiotherapy compared to medical treatment only. The pathophysiological mechanisms of epileptogenesis and the effect of radiation therapy on seizure control are unclear to date. Further prospective studies are needed.
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Affiliation(s)
| | - John H Rossmeisl
- The Department of Veterinary Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Jason Russell
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - Mark A Holmes
- The Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Jo Morris
- The School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Jane M Dobson
- The Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - An E Vanhaesebrouck
- The Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Miller AD, Miller CR, Rossmeisl JH. Canine Primary Intracranial Cancer: A Clinicopathologic and Comparative Review of Glioma, Meningioma, and Choroid Plexus Tumors. Front Oncol 2019; 9:1151. [PMID: 31788444 PMCID: PMC6856054 DOI: 10.3389/fonc.2019.01151] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/16/2019] [Indexed: 12/22/2022] Open
Abstract
In the dog, primary intracranial neoplasia represents ~2-5% of all cancers and is especially common in certain breeds including English and French bulldogs and Boxers. The most common types of primary intracranial cancer in the dog are meningioma, glioma, and choroid plexus tumors, generally occurring in middle aged to older dogs. Much work has recently been done to understand the characteristic imaging and clinicopathologic features of these tumors. The gross and histologic landscape of these tumors in the dog compare favorably to their human counterparts with many similarities noted in histologic patterns, subtype, and grades. Data informing the underlying molecular abnormalities in the canine tumors have only begun to be unraveled, but reveal similar pathways are mutated between canine and human primary intracranial neoplasia. This review will provide an overview of the clinicopathologic features of the three most common forms of primary intracranial cancer in the dog, delve into the comparative aspects between the dog and human neoplasms, and provide an introduction to current standard of care while also highlighting novel, experimental treatments that may help bridge the gap between canine and human cancer therapies.
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Affiliation(s)
- Andrew D. Miller
- Section of Anatomic Pathology, Department of Biomedical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - C. Ryan Miller
- Division of Neuropathology, Department of Pathology, O'Neal Comprehensive Cancer Center and Comprehensive Neuroscience Center, University of Alabama School of Medicine, Birmingham, AL, United States
| | - John H. Rossmeisl
- Section of Neurology and Neurosurgery, Veterinary and Comparative Neuro-Oncology Laboratory, Department of Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
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25
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Four Independent Predictors of Postoperative Seizures After Meningioma Surgery: A Meta-Analysis. World Neurosurg 2019; 130:537-545.e3. [DOI: 10.1016/j.wneu.2019.06.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 12/29/2022]
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Abstract
The World Health Organization classifies diffuse low-grade gliomas (DLGGs) are highly epileptogenic primary brain tumors; epileptic seizures occur in more than 90% of cases. Epileptic seizures and drug resistance progress during the course of DLGGs. The glioma-related epileptogenic mechanisms are multifactorial; epileptogenic foci lie within the infiltrated peritumoral neocortex. A short seizure duration before surgery and a large extent of resection are the main predictors of postoperative seizure control in DLGGs. A supratotal resection of a DLGG can improve postoperative seizure control. Epileptic seizure at diagnosis positively affects DLGGs malignant transformation and overall survival.
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Affiliation(s)
- Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, 1 rue Cabanis, Paris Cedex 14 75674, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; French Glioma Study Group, Réseau d'Etude des Gliomes, REG, Groland, France; Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France.
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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Chen DY, Chen CC, Crawford JR, Wang SG. Tumor-related epilepsy: epidemiology, pathogenesis and management. J Neurooncol 2018; 139:13-21. [PMID: 29797181 DOI: 10.1007/s11060-018-2862-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/04/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Seizure is a common comorbidity in patients with brain tumor. It may be the presenting symptom or develop after the tumor diagnosis. The underlying pathophysiology of brain tumor-related epilepsy remains poorly understood. METHODS A comprehensive literature review of Pubmed English articles from 1980-2017 was performed to summarize current knowledge and treatment options of brain tumor-related epilepsy. RESULTS Multiple factors have been found to contribute to tumor-related epilepsy, including tumor type, speed of tumor growth, location, and tumor burden. The underlying pathogenesis of epilepsy is not clear but perturbations in the peri-tumoral regions, both structural and cellular communications, have been implicated. CONCLUSIONS Surgical and medical treatments of tumor-related epilepsy remain challenging as additional factors such as the extent of surgical resection, interactions with tumor-related oncological treatments and anti-epileptic medication related side effects need to be considered.
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Affiliation(s)
- Dillon Y Chen
- Department of Neuroscience, University of California, San Diego, USA
- Rady Children's Hospital San Diego, San Diego, USA
| | - Clark C Chen
- Department of Neurology, University of Minnesota, Moos Tower 515 Delaware St SE, Suite 13-250, MMC 295 MAYO, Minneapolis, MN, 55455, USA
| | - John R Crawford
- Department of Neuroscience, University of California, San Diego, USA
- Rady Children's Hospital San Diego, San Diego, USA
| | - Sonya G Wang
- Department of Neurology, University of Minnesota, Moos Tower 515 Delaware St SE, Suite 13-250, MMC 295 MAYO, Minneapolis, MN, 55455, USA.
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Chang TW, Lee CY, Jung SM, Lai HY, Chen CT, Yeap MC, Chuang CC, Hsu PW, Chang CN, Tu PH, Lee ST. Correlations between clinical hormone change and pathological features of pituicytoma. Br J Neurosurg 2018; 32:501-508. [PMID: 29749277 DOI: 10.1080/02688697.2018.1472212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Ting-Wei Chang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Ching-Yi Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Shih-Ming Jung
- Departments of Pathology, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Hung-Yi Lai
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chun-Ting Chen
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Mun-Chun Yeap
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chi-Cheng Chuang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Peng-Wei Hsu
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Chen-Nen Chang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Po-Hsun Tu
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
| | - Shih-Tseng Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taoyuan, Taiwan, Republic of China
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Berntsson SG, Merrell RT, Amirian ES, Armstrong GN, Lachance D, Smits A, Zhou R, Jacobs DI, Wrensch MR, Olson SH, Il'yasova D, Claus EB, Barnholtz-Sloan JS, Schildkraut J, Sadetzki S, Johansen C, Houlston RS, Jenkins RB, Bernstein JL, Lai R, Shete S, Amos CI, Bondy ML, Melin BS. Glioma-related seizures in relation to histopathological subtypes: a report from the glioma international case-control study. J Neurol 2018; 265:1432-1442. [PMID: 29687214 PMCID: PMC5990563 DOI: 10.1007/s00415-018-8857-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the distribution of glioma-related seizures and seizure control at the time of tumor diagnosis with respect to tumor histologic subtypes, tumor treatment and patient characteristics, and to compare seizure history preceding tumor diagnosis (or study enrollment) between glioma patients and healthy controls. METHODS The Glioma International Case Control study (GICC) risk factor questionnaire collected information on demographics, past medical/medication history, and occupational history. Cases from eight centers were also asked detailed questions on seizures in relation to glioma diagnosis; cases (n = 4533) and controls (n = 4171) were also asked about seizures less than 2 years from diagnosis and previous seizure history more than 2 years prior to tumor diagnosis, including childhood seizures. RESULTS Low-grade gliomas (LGGs), particularly oligodendrogliomas/oligoastrocytomas, had the highest proportion of glioma-related seizures. Patients with low-grade astrocytoma demonstrated the most medically refractory seizures. A total of 83% of patients were using only one antiepileptic drug (AED), which was levetiracetam in 71% of cases. Gross total resection was strongly associated with reduced seizure frequency (p < 0.009). No significant difference was found between glioma cases and controls in terms of seizure occurring more than 2 years before diagnosis or during childhood. CONCLUSIONS Our study showed that glioma-related seizures were most common in low-grade gliomas. Gross total resection was associated with lower seizure frequency. Additionally, having a history of childhood seizures is not a risk factor ***for developing glioma-related seizures or glioma.
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Affiliation(s)
- Shala G Berntsson
- Department of Neuroscience, Neurology, Uppsala University, 751 85, Uppsala, Sweden.
| | - Ryan T Merrell
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
| | - E Susan Amirian
- Division of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Georgina N Armstrong
- Division of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Lachance
- Department of Neurology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University, 751 85, Uppsala, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Renke Zhou
- Division of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Department of Neurology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Daniel I Jacobs
- Division of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Margaret R Wrensch
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Sara H Olson
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Dora Il'yasova
- Department of Epidemiology and Biostatistics, Georgia State University School of Public Health, Atlanta, Georgia
| | - Elizabeth B Claus
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joellen Schildkraut
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Siegal Sadetzki
- Cancer and Radiation Epidemiology Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Christoffer Johansen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.,Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Richard S Houlston
- Section of Cancer Genetics, Institute of Cancer Research, Sutton, London, Surrey, UK.,Department of Laboratory Medicine and Pathology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Rose Lai
- Departments of Neurology, Neurosurgery, and Preventive Medicine, The University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher I Amos
- Division of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Melissa L Bondy
- Division of Medicine, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Beatrice S Melin
- Department of Radiation Sciences Oncology, Umeå University, Umeå, Sweden
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Stone TJ, Rowell R, Jayasekera BAP, Cunningham MO, Jacques TS. Review: Molecular characteristics of long-term epilepsy-associated tumours (LEATs) and mechanisms for tumour-related epilepsy (TRE). Neuropathol Appl Neurobiol 2018; 44:56-69. [DOI: 10.1111/nan.12459] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/22/2017] [Indexed: 12/14/2022]
Affiliation(s)
- T. J. Stone
- Developmental Biology and Cancer Programme; UCL Great Ormond Street Institute of Child Health; London UK
- Department of Histopathology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - R. Rowell
- Institute of Neuroscience; Newcastle University; Newcastle Upon Tyne UK
- Department of Neurosurgery; Royal Victoria Hospital; Newcastle Upon Tyne UK
| | - B. A. P. Jayasekera
- Institute of Neuroscience; Newcastle University; Newcastle Upon Tyne UK
- Department of Neurosurgery; Royal Victoria Hospital; Newcastle Upon Tyne UK
| | - M. O. Cunningham
- Institute of Neuroscience; Newcastle University; Newcastle Upon Tyne UK
- Department of Neurosurgery; Royal Victoria Hospital; Newcastle Upon Tyne UK
| | - T. S. Jacques
- Developmental Biology and Cancer Programme; UCL Great Ormond Street Institute of Child Health; London UK
- Department of Histopathology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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Seyedi JF, Pedersen CB, Poulsen FR. Risk of seizures before and after neurosurgical treatment of intracranial meningiomas. Clin Neurol Neurosurg 2018; 165:60-66. [PMID: 29316494 DOI: 10.1016/j.clineuro.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/11/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify variables associated with the development of pre- and postoperative seizures in patients who underwent surgical resection of intracranial meningiomas, in a patient cohort not routinely treated prophylactically with antiepileptic drugs (AED). PATIENTS AND METHODS Retrospective cohort study of 295 patients that underwent resection of a supratentorial meningioma at Odense University Hospital in between 2007-2015. Multivariate logistic regression was used to identify variables significantly correlating with pre- and postoperative seizures. Retrospective chart review was used to identify the rates of seizure incidence in patients, and the effect of AED on them. RESULTS The presence of peritumoral edema (OR:18.00, 7.44-43.58) was identified as predictor of preoperative seizure, while headache (OR:0.43, 0.22-0.84) and neurological deficit (OR:0.18, 0.09-0.39) were associated with a reduced incidence of preoperative seizures. The rates of postoperative seizure were increased in meningiomas in the left side (OR:1.91, 1.11-3.29), and reduced for tumor location in the convexity/parasagittal/falx (OR:0.72, 0.59-0.88) as well as in the absence of postoperative complications (OR:0.19, 0.10-0.36). 24.4% of the patients experienced seizures preoperatively, and a complete seizure freedom was achieved in 63.9% of them. 75.6% of the patients did not experience seizures preoperatively, but 15.2% of them then developed seizures postoperatively. A total of 20.3% of the patients experienced seizures after surgery. Time to first seizure in patients that did not experience seizures preoperatively but developed seizures after surgery, was one week (47%). However, first time postoperative seizures were also observed within one month postoperative (21%) and three months after surgery (32%). AED had a treatment success rate of 98.2% in preoperative seizures, and 98.0% in postoperative seizures. CONCLUSION Seizures after supratentorial meningioma surgery is common also in patients with no seizures preoperatively and mainly occurs within the first three postoperative months. AED are effective in controlling seizures.
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Affiliation(s)
- Jian Fernandes Seyedi
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark; OPEN Odense Patient Data Explorative Network, J. B. Winsløws Vej 9 a, Odense Denmark
| | - Christian Bonde Pedersen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark; OPEN Odense Patient Data Explorative Network, J. B. Winsløws Vej 9 a, Odense Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark; OPEN Odense Patient Data Explorative Network, J. B. Winsløws Vej 9 a, Odense Denmark.
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Surgical treatment of neuronal-glial tumors of mesial-basal part of temporal lobe: Long term outcome and control of epilepsy in pediatric patients. Neurol Neurochir Pol 2018; 52:2-8. [DOI: 10.1016/j.pjnns.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/04/2017] [Indexed: 11/20/2022]
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Weisman H, Fried I, Gilboa T, Bennett-Back O, Ekstein D, Shweiki M, Shoshan Y, Benifla M. Prevalence, Characteristics, and Long-Term Prognosis of Epilepsy Associated with Pediatric Brain Tumors. World Neurosurg 2017; 109:e594-e600. [PMID: 29054779 DOI: 10.1016/j.wneu.2017.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We investigated the prevalence, onset, characteristics, and long-term course of epilepsy disease in children who underwent surgical intervention for diagnosed brain tumors. METHODS We reviewed the medical records of children with diagnosed brain tumors who underwent surgery during 2004-2014 at the Hadassah Medical Center. All patients with epilepsy were invited to a clinical visit that included a neurologic examination. The primary outcome measures were neurologic status according to the Glasgow outcome score (GOS) and postoperative seizure outcome according to the Engel system. We compared clinical characteristics according to the timing of epilepsy onset. RESULTS The mean follow-up was 49 months. Of 128 patients included in the study, 44 (34%) had seizures; 23 (18%) developed epilepsy after surgery. Of the 30 patients with epilepsy who survived, 21 (70%) are in Engel class I and 13% Engel are in class II. Forty-five percent of the children are classified as GOS 5. Children who developed epilepsy after surgery were more likely to be in GOS 1-2 than were those who had seizures before surgery (P = 0.0173). Children with seizures were more likely to have cortical tumors and less likely to have tumors of the posterior fossa (P < 0.001). Children who underwent gross total resection were less likely to have epilepsy (P < 0.001). CONCLUSIONS We show a high incidence of epilepsy in the late course of pediatric brain tumor disease. In the long term, seizure outcome was excellent. However, postsurgical onset of epilepsy was associated with a less favorable neurologic outcome.
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Affiliation(s)
- Hadar Weisman
- Hematology-Oncology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Iris Fried
- Hematology-Oncology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Tal Gilboa
- Pediatric Neurology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Odeya Bennett-Back
- Pediatric Neurology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Dana Ekstein
- Neurology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Moatasem Shweiki
- Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Yigal Shoshan
- Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Mony Benifla
- The Pediatric Neurosurgery Unit, Rambam Health Care Campus, Haifa, Israel.
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Opoku-Darko M, Lang ST, Artindale J, Cairncross JG, Sevick RJ, Kelly JJP. Surgical management of incidentally discovered diffusely infiltrating low-grade glioma. J Neurosurg 2017; 129:19-26. [PMID: 28984519 DOI: 10.3171/2017.3.jns17159] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Occasionally, diffusely infiltrating low-grade gliomas (LGGs) are identified as incidental findings in patients who have no signs or symptoms that can be ascribed to the tumors. The diagnosis of incidental, asymptomatic LGGs has become more frequent due to the vast increase in access to medical imaging technology. While management of these lesions remains controversial, early surgery has been suggested to improve outcome. The authors set out to identify and review the characteristics and surgical outcomes of patients who underwent surgical intervention for incidental LGG. METHODS All cases of LGG surgically treated between 2004 and 2016 at the authors' institution were analyzed to identify those that were discovered incidentally. Patients with incidentally discovered LGGs were identified, and their cases were retrospectively reviewed. An "incidental" finding was defined as an abnormality on imaging that was obtained for a reason not attributable to the glioma, such as trauma, headache, screening, or research participation. Kaplan-Meier analysis was performed to determine actuarial rates of overall survival, progression-free survival, and malignant progression-free survival. RESULTS In 34 (6.8%) of 501 adult patients who underwent surgery for LGG, the tumors were discovered incidentally. Headache (26%, n = 9) and screening (21%, n = 7) were the most common indications for brain imaging in this group. Four of these 34 patients had initial biopsy after the tumor was identified on imaging. In 5 cases, the patients opted for immediate resection; the remaining cases were managed with a "watch-and-wait" approach, with intervention undertaken only after radiological or clinical evidence of disease progression. The mean duration of follow-up for all 34 cases was 5 years. Twelve patients (35.3%) had disease progression, with an average time to progression of 43.8 months (range 3-105 months). There were 5 cases (14.7%) of malignant progression and 4 deaths (11.8%). Oligodendroglioma was diagnosed in 16 cases (47%) and astrocytoma in 15 (44%). Twenty-five patients (74%) had IDH1 mutation and demonstrated prolonged survival. Only 2 patients had mild surgery-related complications, and 16 patients (47%) developed epilepsy during the course of the disease. CONCLUSIONS In this retrospective analysis of cases of incidentally discovered LGGs, the tumors were surgically removed with minimal surgical risk. In patients with incidental LGGs there is improved overall survival relative to median survival for patients with symptomatic LGGS, which is likely attributable to the underlying favorable biology of the disease indicated by the presence of IDH1 mutation in 74% of the cases.
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Affiliation(s)
| | | | | | - J Gregory Cairncross
- 2The Arne Charbonneau Cancer Institute, and.,Departments of3Clinical Neurosciences and
| | | | - John J P Kelly
- 1Division of Neurosurgery.,2The Arne Charbonneau Cancer Institute, and
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Sánchez Fernández I, Loddenkemper T. Seizures caused by brain tumors in children. Seizure 2016; 44:98-107. [PMID: 28017579 DOI: 10.1016/j.seizure.2016.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To review the epidemiology, clinical features, and treatment of seizures secondary to pediatric brain tumors. METHOD Literature review. RESULTS Pediatric brain tumors are the most common solid pediatric tumor and the most common cause of death in pediatric cancer. Seizures are one of the most common symptoms of pediatric brain tumors. Factors associated with increased risk of seizures include supratentorial location, gray matter involvement, low-grade, and certain histological features-especially dysembryoplastic neuroepithelial tumor, ganglioglioma, and oligodendroglioma. Leukemic infiltration of the brain, brain metastases of solid tumors, and brain injury secondary to chemotherapy or radiotherapy can also cause seizures. Mechanisms by which brain tumors cause seizures include metabolic, and neurotransmitter changes in peritumoral brain, morphologic changes - including malformation of cortical development - in peritumoral brain, and presence of peritumoral blood products, gliosis, and necrosis. As there is a high degree of uncertainty on how effective different antiepileptic drugs are for seizures caused by brain tumors, choices are often driven by the interaction and side effect profile. Classic antiepileptic drugs - phenobarbital, phenytoin, or carbamazepine - should be avoided as they may alter the metabolism of chemotherapeutic agents. Newer drugs - valproate, lamotrigine, topiramate, zonisamide, and levetiracetam - may be the preferred option in patients with tumors because of their very limited interaction with chemotherapy. CONCLUSION Seizures are a common presentation of pediatric brain tumors, especially in supratentorial tumors with gray matter involvement. Antiepileptic drug therapy is usually driven by the interaction and side effect profile and newer drugs with few interactions are generally preferred.
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Spain.
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Epilepsy surgery for pediatric low-grade gliomas of the cerebral hemispheres: neurosurgical considerations and outcomes. Childs Nerv Syst 2016; 32:1923-30. [PMID: 27659834 DOI: 10.1007/s00381-016-3162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pediatric low-grade tumors are found in roughly 1-3 % of patients with childhood epilepsy; seizures associated with these tumors are often medically refractory and often present a significant morbidity, greater than the presence of the tumor itself. DISCUSSION The unique morbidity of the seizures often requires an epilepsy surgical approach over a standard oncologic resection to achieve a reduction in morbidity for the child. Multiple quality-of-life studies have shown that unless a patient is seizure-free, they remain disabled throughout their life; the best way to achieve this in our patient population is with a multidisciplinary team approach with treatment goals focusing primarily on the epilepsy. CONCLUSION In those patients treated with gross total resection, roughly 80 % will have an Engel class I outcome and 90 % will achieve some reduction in seizure frequency with a significant improvement in quality of life.
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Mohme M, Emami P, Regelsberger J, Matschke J, Lamszus K, Westphal M, Eicker SO. Secretory Meningiomas: Increased Prevalence of Seizures Secondary to Edema Formation in a Rare Histologic Subtype. World Neurosurg 2016; 92:418-425. [DOI: 10.1016/j.wneu.2016.05.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 01/27/2023]
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Messerer M, Richoz B, Cossu G, Dhermain F, Hottinger A, Parker F, Levivier M, Daniel R. Recent advances in the management of atypical meningiomas. Neurochirurgie 2016; 62:213-22. [DOI: 10.1016/j.neuchi.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/17/2016] [Accepted: 02/26/2016] [Indexed: 11/26/2022]
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Kaur T, Manchanda S, Saini V, Lakhman SS, Kaur G. Efficacy of Anti-Epileptic Drugs in the Treatment of Tumor and Its Associated Epilepsy: An in vitro Perspective. Ann Neurosci 2016; 23:33-43. [PMID: 27536020 PMCID: PMC4934412 DOI: 10.1159/000443554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/24/2015] [Indexed: 11/23/2022] Open
Abstract
The change in the therapeutic targets from neuron to glia has proved beneficial in the treatment of many psychiatric disorders. The anti-epileptic drugs (AEDs) have been widely prescribed for the treatment of partial and complete seizures, bipolar disorder among others. The current study was carried out to explore the efficacy of some conventional and novel AEDs for the treatment of tumor-associated epilepsy which develops in 29-49% of the patients diagnosed with brain tumors. We used C6 glioma cell line as model system to study the effect of selected AEDs, viz., gabapentin (GBP), valproic acid (VPA) and topiramate (TPM). Morphometry, cell cycle analysis, apoptosis, expression of different protein markers, viz., GFAP, HSP70 and nuclear factor-κB (NFκB) were studied in AED-treated cultures. The study was further extended to rat hypothalamic primary explant cultures, and cell migration and expression of plasticity markers - neural cell adhesion molecule (NCAM) and polysialylation of NCAM (PSA-NCAM) - were studied in the explants. TPM was observed to show more pronounced increase in apoptosis of glioblastoma cells accompanied by significant downregulation in the expression of HSP70 and NFκB. TPM-treated explants also showed highest process ramification and cellular migration accompanied by intense expression of the plasticity markers as compared to those treated with GBP and VPA. Among the 3 AEDs tested, TPM was observed to show more promising effects on cytoprotection and plasticity of C6 glioma cells.
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Affiliation(s)
- Taranjeet Kaur
- Department of Biotechnology, Guru Nanak Dev University, Amritsar, India
| | - Shaffi Manchanda
- Department of Biotechnology, Guru Nanak Dev University, Amritsar, India
| | - Vedangana Saini
- Department of Biotechnology, Guru Nanak Dev University, Amritsar, India
| | - Sukhwinder S Lakhman
- Department of Pharmaceutical, Social and Administrative Sciences, D'Youville College School of Pharmacy, Buffalo, N.Y., USA
| | - Gurcharan Kaur
- Department of Biotechnology, Guru Nanak Dev University, Amritsar, India
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Ochiai S, Nomoto Y, Yamashita Y, Watanabe Y, Toyomasu Y, Kawamura T, Takada A, Ii N, Kobayashi S, Sakuma H. Roles of Valproic Acid in Improving Radiation Therapy for Glioblastoma: a Review of Literature Focusing on Clinical Evidence. Asian Pac J Cancer Prev 2016; 17:463-6. [DOI: 10.7314/apjcp.2016.17.2.463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ravat S, Iyer V, Panchal K, Muzumdar D, Kulkarni A. Surgical outcomes in patients with intraoperative Electrocorticography (EcoG) guided epilepsy surgery-experiences of a tertiary care centre in India. Int J Surg 2016; 36:420-428. [PMID: 26892714 DOI: 10.1016/j.ijsu.2016.02.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/30/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Comprehensive Epilepsy Surgery Program was started in 2001 at K.E.M. Hospital, Mumbai with the aim of performing epilepsy surgeries at highly concessional rates. We have started using intraoperative Electrocorticography (EcoG) since 2009 in patients with tumors, Mesial Temporal Sclerosis (MTS) plus and focal cortical dysplasia (FCD). This study highlights our experience with EcoG and it's utility in epilepsy surgery.introduction METHODS: 51 patients with drug resistant epilepsy due to temporal and extra-temporal tumors, MTS plus and FCD underwent pre-surgical evaluation and ECoG guided epilepsy surgery through our program. The surgical procedures employed included intraoperative EcoG guided lesionectomy or a lesionectomy with Anterior Temporal Lobectomy (ATL). Postoperative MRI and EEG were done. Seizure freedom was categorized as per Engel's classification. RESULTS At a mean follow up of 33 months (range: 14-69 months), 43 out of 51(84.31%) patients were completely seizure free post-surgery (Engel's Class I). Among the patients who were not seizure free, 3 patients were in Engel's Class II and 5 patients were in Engel's Class III. Presence of a residual lesion on postoperative MRI (p < 0.001), abnormal postoperative EEG (p < 0.001) and persistent spikes on post-resection EcoG (p < 0.05) had a significant statistical association with poor seizure freedom post-surgery. CONCLUSION The success of epilepsy surgery depends upon accurate localization and complete resection of the epileptogenic tissue, both of which are aided by intraoperative EcoG.Thus, intraoperative EcoG is a useful adjunct in epilepsy surgery to achieve optimal seizure freedom in cases of MTS plus, focal cortical dysplasia and tumors. Even the patients who are not seizure free can achieve worthwhile improvement post surgery.
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Affiliation(s)
- Sangeeta Ravat
- Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India.
| | - Vivek Iyer
- Dept. of Neurology, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India.
| | - Keyurkumar Panchal
- Dept. of Neurology, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India.
| | - Dattatraya Muzumdar
- Dept. of Neurosurgery, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India.
| | - Abhijit Kulkarni
- Department of Neurosurgery, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India.
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Alentorn A, Hoang-Xuan K, Mikkelsen T. Presenting signs and symptoms in brain tumors. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:19-26. [PMID: 26948346 DOI: 10.1016/b978-0-12-802997-8.00002-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Focal symptoms and signs occurring during brain tumor clinical presentation are dependent on a number of factors. Location and rate of growth are the most critical, followed by overall lesion size and nature, whether infiltrating or causing the displacement of neural structures, but also the presence or extent of associated pathology, including edema, hemorrhage, vascular compromise, and cerebrospinal fluid obstruction. Mechanisms of presenting symptomatology can be divided into tumor and peritumoral factors. Tumor factors include histology, for example, in that seizures are common in patients with certain low-grade gliomas. Peritumoral factors, including regional hypoxia and ionic changes in the peritumoral zone, may influence neuronal activity and extracellular glutamate may be associated with neuronal hyperexcitability. Blood-brain barrier breakdown may predispose to seizure and localized neuronal dysfunction. Finally, signs and symptoms in brain tumors can be generalized, associated with increased intracranial brain pressure, but can also be localized, based on the involvement of the major structures of the central nervous system.
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Affiliation(s)
- Agusti Alentorn
- Department of Neurology 2, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Inserm Experimental Neuro-Oncology Laboratory, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology 2, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Inserm Experimental Neuro-Oncology Laboratory, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Paris, France.
| | - Tom Mikkelsen
- Hermelin Brain Tumor Center and Departments of Neurology and Neurosurgery, Henry Ford Hospital, Detroit, MI, USA; Wayne State University, Detroit, MI, USA
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Tandon V, Bansal S, Chandra PS, Suri A, Tripathi M, Sharma MC, Sarkari A, Mahapatra AK. Ganglioglioma: Single-institutional experience of 24 cases with review of literature. Asian J Neurosurg 2016; 11:407-411. [PMID: 27695546 PMCID: PMC4974967 DOI: 10.4103/1793-5482.153500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Ganglioglioma is a common seizure associated tumor. The goal of this study was to observe the postoperative outcome in patients with gangliogliomas. Material and Methods: A total 24 patients with gangliogliomas who underwent surgery at our institute from 2008 to 2011 were included. There were 13 males (54%) in our study. A retrospective analysis for the demographic profile, surgery and outcome was performed using STATA software. Literature on this subject was also reviewed, MEDLINE and PUBMED databases were searched. Observations: Sixteen patients presented with signs and symptoms of raised intracranial pressure and 12 patients had seizure disorder. Average age at surgery was 20 years (range 7-50 years). Twelve each were located in the temporal lobe and extra-temporal location. Intra-operative electrocorticography (ECoG) alone in three and image guidance alone were used in two patients, respectively. Both ECoG and image guidance were used in one patient and none of them was used in 18 patients. Gross total resection was achieved in 17 patients. After a mean follow-up of 1.6 years (range 3 months to 2.5 years), out of 12 patients with preoperative seizures, 10 (83.3%) were seizure free (Engel class-I) and 2 (16.6%) belonged to Engel class-II. None of the factors, including age at surgery, seizure duration prior to surgery, type of seizures, use of intra-operative ECoG and image guidance, extent of tumor resection, and surgical strategy proved to have significant correlation with postoperative seizure outcome. Conclusions: Surgical treatment is effective and safe for patients with gangliogliomas. Neither intra-operative ECoG nor image guidance necessarily leads to better seizure control, although they are useful adjunct for achieving safe and complete tumor resection.
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Affiliation(s)
- Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Avijit Sarkari
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Armstrong TS, Grant R, Gilbert MR, Lee JW, Norden AD. Epilepsy in glioma patients: mechanisms, management, and impact of anticonvulsant therapy. Neuro Oncol 2015; 18:779-89. [PMID: 26527735 DOI: 10.1093/neuonc/nov269] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/01/2015] [Indexed: 12/16/2022] Open
Abstract
Seizures are a well-recognized symptom of primary brain tumors, and anticonvulsant use is common. This paper provides an overview of epilepsy and the use of anticonvulsants in glioma patients. Overall incidence and mechanisms of epileptogenesis are reviewed. Factors to consider with the use of antiepileptic drugs (AEDs) including incidence during the disease trajectory and prophylaxis along with considerations in the selection of anticonvulsant use (ie, potential side effects, drug interactions, adverse effects, and impact on survival) are also reviewed. Finally, areas for future research and exploring the pathophysiology and use of AEDs in this population are also discussed.
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Affiliation(s)
- Terri S Armstrong
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Robin Grant
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Mark R Gilbert
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Jong Woo Lee
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Andrew D Norden
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
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Berendsen S, Varkila M, Kroonen J, Seute T, Snijders TJ, Kauw F, Spliet WGM, Willems M, Poulet C, Broekman ML, Bours V, Robe PA. Prognostic relevance of epilepsy at presentation in glioblastoma patients. Neuro Oncol 2015; 18:700-6. [PMID: 26420896 DOI: 10.1093/neuonc/nov238] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/24/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Epileptogenic glioblastomas are thought to convey a favorable prognosis, either due to early diagnosis or potential antitumor effects of antiepileptic drugs. We investigated the relationship between survival and epilepsy at presentation, early diagnosis, and antiepileptic drug therapy in glioblastoma patients. METHODS Multivariable Cox regression was applied to survival data of 647 consecutive patients diagnosed with de novo glioblastoma between 2005 and 2013 in order to investigate the association between epilepsy and survival in glioblastoma patients. In addition, we quantified the association between survival and valproic acid (VPA) treatment. RESULTS Epilepsy correlated positively with survival (HR: 0.75 (95% CI: 0.61-0.92), P < .01). This effect is independent of age, sex, performance status, type of surgery, adjuvant therapy, tumor location, and tumor volume, suggesting that this positive correlation cannot be attributed solely to early diagnosis. For patients who presented with epilepsy, the use of the antiepileptic drug VPA did not associate with survival when compared with patients who did not receive VPA treatment. CONCLUSION Epilepsy is an independent prognostic factor for longer survival in glioblastoma patients. This prognostic effect is not solely explained by early diagnosis, and survival is not associated with VPA treatment.
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Affiliation(s)
- Sharon Berendsen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Meri Varkila
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Jérôme Kroonen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Tatjana Seute
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Tom J Snijders
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Frans Kauw
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Wim G M Spliet
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Marie Willems
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Christophe Poulet
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Marike L Broekman
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Vincent Bours
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Pierre A Robe
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
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Kirschstein T, Köhling R. Animal models of tumour-associated epilepsy. J Neurosci Methods 2015; 260:109-17. [PMID: 26092434 DOI: 10.1016/j.jneumeth.2015.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/26/2023]
Abstract
Brain tumours cause a sizeable proportion of epilepsies in adulthood, and actually can be etiologically responsible also for childhood epilepsies. Conversely, seizures are often first clinical signs of a brain tumour. Nevertheless, several issues of brain-tumour associated seizures and epilepsies are far from understood, or clarified regarding clinical consensus. These include both the specific mechanisms of epileptogenesis related to different tumour types, the possible relationship between malignancy and seizure emergence, the interaction between tumour mass and surrounding neuronal networks, and - not least - the best treatment options depending on different tumour types. To investigate these issues, experimental models of tumour-induced epilepsies are necessary. This review concentrates on the description of currently used models, focusing on methodological aspects. It highlights advantages and shortcomings of these models, and identifies future experimental challenges.
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Affiliation(s)
- Timo Kirschstein
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Gertrudenstrasse 9, 18057 Rostock, Germany
| | - Rüdiger Köhling
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Gertrudenstrasse 9, 18057 Rostock, Germany.
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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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Iijima K, Hirato M, Miyagishima T, Horiguchi K, Sugawara K, Hirato J, Yokoo H, Yoshimoto Y. Microrecording and image-guided stereotactic biopsy of deep-seated brain tumors. J Neurosurg 2015; 123:978-88. [PMID: 25816085 DOI: 10.3171/2014.10.jns14963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Image-guided stereotactic brain tumor biopsy cannot easily obtain samples of small deep-seated tumor or selectively sample the most viable region of malignant tumor. Image-guided stereotactic biopsy in combination with depth microrecording was evaluated to solve such problems. METHODS Operative records, MRI findings, and pathological specimens were evaluated in 12 patients with small deep-seated brain tumor, in which image-guided stereotactic biopsy was performed with the aid of depth microrecording. The tumors were located in the caudate nucleus (1 patient), thalamus (7 patients), midbrain (2 patients), and cortex (2 patients). Surgery was performed with a frameless stereotactic system in 3 patients and with a frame-based stereotactic system in 9 patients. Microrecording was performed to study the electrical activities along the trajectory in the deep brain structures and the tumor. The correlations were studied between the electrophysiological, MRI, and pathological findings. Thirty-two patients with surface or large brain tumor were also studied, in whom image-guided stereotactic biopsy without microrecording was performed. RESULTS The diagnostic yield in the group with microrecording was 100% (low-grade glioma 4, high-grade glioma 4, diffuse large B-cell lymphoma 3, and germinoma 1), which was comparable to 93.8% in the group without microrecording. The postoperative complication rate was as low as that of the conventional image-guided method without using microelectrode recording, and the mortality rate was 0%, although the target lesions were small and deep-seated in all cases. Depth microrecording revealed disappearance of neural activity in the tumor regardless of the tumor type. Neural activity began to decrease from 6.3 ± 4.5 mm (mean ± SD) above the point of complete disappearance along the trajectory. Burst discharges were observed in 6 of the 12 cases, from 3 ± 1.4 mm above the point of decrease of neural activity. Injury discharges were often found at 0.5-1 mm along the trajectory between the area of decreased and disappeared neural activity. Close correlations between electrophysiological, MRI, and histological findings could be found in some cases. CONCLUSIONS Image-guided stereotactic biopsy performed using depth microrecording was safe, it provided accurate positional information in real time, and it could distinguish the tumor from brain structures during surgery. Moreover, this technique has potential for studying the epileptogenicity of the brain tumor.
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Affiliation(s)
| | | | | | | | | | - Junko Hirato
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hideaki Yokoo
- Human Pathology, Gunma University Graduate School of Medicine; and
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Zhang BO, Wang D, Guo Y, Yu J. Clinical multifactorial analysis of early postoperative seizures in elderly patients following meningioma resection. Mol Clin Oncol 2015; 3:501-505. [PMID: 26137257 DOI: 10.3892/mco.2015.493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/08/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to identify the major factors correlated with early postoperative seizures in elderly patients who had undergone a meningioma resection, and subsequently, to develop a logistic regression equation for assessing the seizures risk. Fourteen factors possibly correlated with early postoperative seizures in a cohort of 209 elderly patients who had undergone meningioma resection, as analyzed by multifactorial stepwise logistic regression. Phenobarbital sodium (0.1 g, intramuscularly) was administered to all 209 patients 30 min prior to undergoing surgery. All the patients had no previous history of seizures. The correlation of the 14 clinical factors (gender, tumor site, dyskinesia, peritumoral brain edema (PTBE), tumor diameter, pre- and postoperative prophylaxes, surgery time, tumor adhesion, circumscription, blood supply, intraoperative transfusion, original site of the tumor and dysphasia) was assessed in association with the risk for post-operative seizures. Tumor diameter, postoperative prophylactic antiepileptic drug (PPAD) administration, PTBE and tumor site were entered as risk factors into a mathematical regression model. The odds ratio (OR) of the tumor diameter was >1, and PPAD administration showed an OR >1, relative to a non-prophylactic group. A logistic regression equation was obtained and the sensitivity, specificity and misdiagnosis rates were 91.4, 74.3 and 25.7%, respectively. Tumor diameter, PPAD administration, PTBE and tumor site were closely correlated with early postoperative seizures; PTBE and PPAD administration were risk and protective factors, respectively.
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Affiliation(s)
- B O Zhang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Dan Wang
- Department of Ophthalmology, First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, P.R. China
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