Factors influencing seizures in adult patients with supratentorial astrocytic tumors

Hwang, Shiuh-Lin; Lin, Chih-Lung; Lee, K.-S.; Lieu, Ann-Shung; Kuo, Tai-Hong; Chang, Chih-Hui; Yen, Cheng-Fang; Loh, Joon‐Khim; Huang, Tsung-Yi; Howng, Shen-Long

doi:10.1007/s00701-004-0266-8

Cited by 40 publications

(35 citation statements)

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“…The risk was 68% in 107 patients undergoing surgical resection for a glioma in our series. The frequency of seizures in the course of the disease noted here is well above that reported previously [8][9][10] and reflects an unusually high seizure incidence of 41 and 61% in patients newly diagnosed with WHO grade III and IV tumors in our cohort (table 2). Apart from this our cohort matched previously reported series in many respects: higher risk of seizure in low-grade compared with high-grade tumors, oligodendroglial compared with astrocytic histology, and in temporal > parietal > frontal > occipital glioma localization.…”

Section: Discussionsupporting

confidence: 71%

Pharmacotherapy of Epileptic Seizures in Glioma Patients: Who, When, Why and How Long?

et al. 2005

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Background: The risk for patients with primary brain tumors of experiencing an epileptic seizure at least once in the course of disease probably exceeds 50%, depending on tumor location and tumor type. Several aspects regarding the role of anticonvulsants in the treatment of brain tumor patients have remained controversial. Patients and Methods: We reviewed the seizure history in 107 patients undergoing a surgical procedure for glioma at our institution. Results: The overall seizure incidence was 68%. Pre-operative seizures did not predict the occurrence of post-operative seizures. After surgery, postoperative chemo- or radiotherapy and anticonvulsive therapy one third of patients was seizure-free whereas one third showed frequent seizures despite this treatment. Seizure frequency increased regardless of anticonvulsive treatment with progressive or recurrent tumor growth. Conclusions: Based on a literature review and our institutional experience, we delineate some recommendations for the management of seizures in patients with brain tumors.

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Section: Discussionsupporting

confidence: 71%

Pharmacotherapy of Epileptic Seizures in Glioma Patients: Who, When, Why and How Long?

et al. 2005

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“…Among primary brain tumors, the risk for seizures is higher for patients with low grade gliomas and with tumors located in the temporal lobe (5,14,29). In patients with brain metastasis seizures occur with a slightly lower incidence of 20-35%.…”

Section: Introductionmentioning

confidence: 99%

“…Most patients with a suspected brain tumor then need to undergo a neurosurgical procedure, which is in itself associated with an increased risk of seizures. Thus, the control of seizures in the perioperative phase is an important goal in brain tumor management (4, 5,11,13,20,25,29).…”

Section: Introductionmentioning

confidence: 99%

Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial

et al. 2011

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BACKGROUND: Levetiracetam (LEV) is a newer anticonvulsant with a favorable safety profile. There seem to be no relevant drug interactions, and an intravenous formulation is available. Therefore, LEV might be a suitable drug for the perioperative anticonvulsive therapy of patients with suspected brain tumors undergoing neurosurgery. METHODS: In this prospective study (NCT00571155) patients with suspected primary brain tumors and tumor-related seizures were perioperatively treated with oral and intravenous LEV up to 4 weeks before and until 4 weeks after a planned neurosurgical procedure. FINDINGS: Thirty patients with brain tumor-related seizures and intended neurosurgery were included. Three patients did not undergo the scheduled surgery after enrollment, and two patients were lost to follow-up. Therefore, 25 patients were fully evaluable. After initiation of therapy with LEV, 100% of the patients were seizure-free in the pre-surgery phase (3 days up to 4 weeks before surgery), 88% in the 48 h post-surgery phase and 84% in the early follow-up phase (48 h to 4 weeks post surgery). Treatment failure even after dose escalation to 3,000 mg/day occurred in three patients. No serious adverse events related to the treatment with LEV occurred. CONCLUSION: Our data show the feasibility and safety of oral and intravenous LEV in the perioperative treatment of tumor-related seizures. Although this was a single arm study, the efficacy of LEV appears promising. Considering the side effects and interactions of other anticonvulsants, LEV seems to be a favorable option in the perioperative treatment of brain tumor-related seizures.

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“…55 In astrocytic tumor series of patients with LGG, approximately 20%-23% had postoperative seizures; more than half of these occurred within 3 months after surgery. 18,19 The presence of irritative substances in the first weeks following surgery, such as hemosiderin deposits, inflammatory substances, edema, and/or electrolytic disturbances might explain the appearance of seizures in this critical time. 25,41 However, in the current literature, there are no clear data with regard to the epilepsy risk related to surgery in ILGG.…”

Section: Risk Of Seizures In the Early Postoperative Periodmentioning

confidence: 99%

Is there a risk of seizures in “preventive” awake surgery for incidental diffuse low-grade gliomas?

Lima

Duffau

2015

JNS

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A WHO Grade II glioma (diffuse low-grade glioma [LGG]) is a continuously growing lesion that migrates along white matter pathways and that will inescapably evolve toward a higher grade of malignancy. 39This tumor is usually revealed by inaugural seizures in young adults with no or only mild neurological deficits. 11Despite the lack of prospective randomized trials, a large amount of data reported in the modern literature strongly supports the impact of early and maximal resection on the natural history of the disease, by delaying malignant transformation and thus by significantly increasing survival. 1,15,20,21,30,46,49 Recently the French Glioma Network published the largest surgical series of LGG ever reported, in which multivariate analysis was used to show that extent abbreviatioNs AED = antiepileptic drug; EOR = extent of resection; ILGG = incidental low-grade glioma; KPS = Karnofsky Performance Scale. submitted June 22, 2014. accepted September 10, 2014. iNclude wheN citiNg Published online February 27, 2015; DOI: 10.3171/2014.9.JNS141396. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.Is there a risk of seizures in "preventive" awake surgery for incidental diffuse low-grade gliomas? 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) ...

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Factors influencing seizures in adult patients with supratentorial astrocytic tumors

Cited by 40 publications

References 24 publications

Pharmacotherapy of Epileptic Seizures in Glioma Patients: Who, When, Why and How Long?

Pharmacotherapy of Epileptic Seizures in Glioma Patients: Who, When, Why and How Long?

Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial

Is there a risk of seizures in “preventive” awake surgery for incidental diffuse low-grade gliomas?

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