Long-term seizure outcomes in adult patients undergoing primary resection of malignant brain astrocytomas

Clinical article

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Object

Seizures are a common presenting symptom and cause of morbidity for patients with malignant astrocytomas. The authors set out to determine preoperative seizure characteristics, effects of surgery on seizure control, and factors associated with prolonged seizure control in patients with malignant astrocytomas.

Methods

Cases involving adult patients who underwent primary resection of a hemispheric anaplastic astrocytoma (AA) or glioblastoma multiforme (GBM) at the Johns Hopkins Medical Institutions between 1996 and 2006 were retrospectively reviewed. Multivariate logistical regression analysis was used to identify associations with pre-operative seizures, and multivariate proportional hazards regression analyses were used to identify associations with prolonged seizure control following resection.

Results

Of the 648 patients (505 with GBM, 143 with AA) in this series, 153 (24%) presented with seizures. The factors more commonly associated with preoperative seizures were AA pathology (p = 0.03), temporal lobe involvement (p = 0.04), and cortical location (p = 0.04), while the factors less commonly associated with preoperative seizures were greater age (p = 0.03) and larger tumor size (p ≤ 0.001). Among those patients with a history of seizures, outcome 12 months after surgery was Engel Class I (seizure free) in 77%, Class II (rare seizures) in 12%, Class III (meaningful improvement) in 6%, and Class IV (no improvement) in 5%. Postoperative seizures were rare in patients without a history of preoperative seizures. The factor positively associated with prolonged seizure control was increased Karnofsky Performance Scale score (p = 0.002), while the factors negatively associated with seizure control were preoperative uncontrolled seizures (p = 0.03) and parietal lobe involvement (p = 0.005). Seizure recurrence in patients with postoperative seizure control was independently associated with tumor recurrence (p = 0.006).

Conclusions

The identification and consideration of factors associated with prolonged seizure control may help guide treatment strategies aimed at improving the quality of life for patients with malignant astrocytomas.

Abbreviations used in this paper: AA = anaplastic astrocytoma; AED = antiepileptic drug; BCNU = carmustine; CCNU = lomustine; GBM = glioblastoma multiforme; IQR = interquartile range; KPS = Karnofsky Performance Scale; PCV = procarbazine, lomustine, vincristine.

Article Information

Address correspondence to: Alfredo Quiñones-Hinojosa, M.D., The Johns Hopkins Hospital, Department of Neurosurgery, Johns Hopkins University, CRB II, 1550 Orleans Street, Room 247, Baltimore, Maryland 21231. email: aquinon2@jhmi.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Kaplan–Meier plot of seizure control in all patients with malignant gliomas. The 6-, 12-, and 18-month seizure-free survival rates were 85, 69, and 52%, respectively.

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    Kaplan-Meier plots of seizure control in patients with GBM and those with AA. For patients undergoing primary resection of a GBM, the 6-, 12-, and 18-month seizure-free survival rates were 82, 73, and 50%, respectively. For patients undergoing primary resection of an AA, the 6-, 12-, and 18-month seizure-free survival rates were 91, 68, and 54%, respectively. There was no significant difference in seizure control between patients with GBM and AA (p = 0.47).

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