Clinical characteristics of low‐grade tumor‐related epilepsy and its predictors for surgical outcome

Abstract

Objectives: Low-grade tumors are the most common neoplasms inducing focal epilepsy; however, the short-and medium-term efficacy of surgery in epilepsy patients with low-grade tumors remains underappreciated. This study aims to summarize the clinical characteristics of epilepsy patients with low-grade tumors and to identify factors associated with postsurgical seizure-free outcomes. Methods: We retrospectively reviewed consecutive patients with lowgrade tumors who underwent subsequent epilepsy surgery in our epilepsy center, between 2012 and 2018 with a minimum follow-up of 1 year. Using Engel's classification and Kaplan-Meier survival analysis, we assessed postoperative seizure freedom over time. Demographical, electroclinical, and other presurgical evaluations were then evaluated for association with postoperative seizure outcome. Results: The cohort included a total of 132 patients: 79 males and 53 females. Among them, 110 (83.33%) were seizure-free through their last followup. The Engel class I outcomes were 90.15%, 87.76%, 85.53%, 82.46%, and 73.17% at the end of the 1st, 2nd, 3rd, 4th, and 5th postoperative years, respectively. Multivariate logistic analysis revealed that longer epilepsy duration (p < 0.001, OR 1.091, 95% CI 1.040-1.144) and incomplete resection (p = 0.009, OR 3.673, 95% CI 1.393-9.684) were independently associated with seizure recurrence through the last follow-up. Conclusions: Surgical treatment for seizure control in patients with low-grade tumors provides excellent shortand median-term outcomes.

Resective surgery for patients with frontal lobe diffuse low-grade glioma-related epilepsy: predictors of seizure outcomes

“…Total tumor resection is a well-known predictor of favorable postoperative seizure outcomes in patients with DLGG-related epilepsy. 25 , 26 , 28 In accordance with these study results, we also found such associations in this study, despite the differences in the patient cohort. Patients with residual tumors after surgery tend to have unfavorable seizure outcomes.…”

“…Factors including the extent of resection, seizure duration, age at surgery, and tumor location have been reported as predictors of seizure outcomes in patients with DLGG-related epilepsy. [24][25][26][27] In the present study, only patients with frontal DLGG-related epilepsy were included, and we found that total tumor removal and older age at seizure onset were independent predictors of favorable seizure outcomes.…”

Predictors of seizure outcomes in patients with diffuse low‐grade glioma‐related epilepsy after complete glioma removal

“…This may be because only patients with complete tumor resection were included in our research. Complications following the operation happened in 10.17% of cases, and permanent neurological impairments occurred in 5.93% of patients, similar to previous studies on surgical treatment for DLGG 2,8 . Notably, in this case series, patients who experienced surgical complications were seizure‐free at the final follow‐up.…”

“…Resection surgery is presently considered the most effective treatment for seizure control in patients with DLGG‐related epilepsy 1,7 . The extent of tumor excision is one of the most important predictors of seizure control after operation and is partly attributed to the neurotransmitter released by the residual tumor 8–10 . Accordingly, maximal safe resection of tumors is recommended as the standard of care for DLGG‐related epilepsy 11 .…”

“…Identifying the predictors of seizure outcomes after complete tumor excision may help improve patient selection and management during the perioperative period. Although numerous studies have examined predictors of seizure outcomes in patients with DLGG‐related epilepsy after surgery, the predictors of seizure outcomes after complete tumor resection remain elusive; previous studies included patients with different extents of tumor resection 2,8,9,12,13 …”