Predictors of seizure freedom after resection of supratentorial low-grade gliomas

A review

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Object

Seizures are the most frequent presenting symptom in patients with low-grade gliomas (LGGs), and significantly influence quality of life if they are uncontrolled. Achieving freedom from seizures is of utmost importance in surgical planning, but the factors associated with seizure control remain incompletely understood.

Methods

The authors performed a systematic literature review of seizure outcomes after resection of LGGs causing seizures, examining 773 patients across 20 published series. Rates of seizure freedom were stratified across 7 variables: patient age, tumor location, preoperative seizure control with medication, seizure semiology, epilepsy duration, extent of resection, and the use of intraoperative electrocorticography (ECoG).

Results

Gross-total resection was most predictive of complete seizure freedom, when compared with subtotal resection (OR 3.41, 95% CI 2.36–4.93). Other predictors of seizure freedom included preoperative seizure control on antiepileptic medication (OR 2.12, 95% CI 1.33–3.38) and duration of seizures of ≤ 1 year (OR 1.85, 95% CI 1.22–2.79). Patients with simple partial seizure semiology achieved seizure freedom less often than those with complex partial, generalized, or mixed seizure types (OR 0.46, 95% CI 0.26–0.80). No significant differences in seizure outcome were observed between adults versus children, patients with temporal lobe versus extratemporal tumors, or with the use of intraoperative ECoG.

Conclusions

Seizure control is one of the most important considerations in planning surgery for low-grade brain tumors. Gross-total resection is a critical factor in achieving seizure freedom.

Abbreviations used in this paper: AED = antiepileptic drug; ECoG = electrocorticography; LGG = low-grade glioma.
Article Information

Contributor Notes

Address correspondence to: Edward F. Chang, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, California 94143-0112. email: ChangED@neurosurg.ucsf.edu.Please include this information when citing this paper: published online April 29, 2011; DOI: 10.3171/2011.3.JNS1153.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Alexiou GAVarela MSfakianos GProdromou N: Benign lesions accompanied by intractable epilepsy in children. J Child Neurol 24:6977002009

    • Search Google Scholar
    • Export Citation
  • 2

    Bauer RDobesberger JUnterhofer CUnterberger IWalser GBauer G: Outcome of adult patients with temporal lobe tumours and medically refractory focal epilepsy. Acta Neurochir (Wien) 149:121112172007

    • Search Google Scholar
    • Export Citation
  • 3

    Beatty RA: The focal motor seizures as a false localizing sign. Neurology 15:7527551965

  • 4

    Benifla MOtsubo HOchi AWeiss SKDonner EJShroff M: Temporal lobe surgery for intractable epilepsy in children: an analysis of outcomes in 126 children. Neurosurgery 59:120312142006

    • Search Google Scholar
    • Export Citation
  • 5

    Berger MSGhatan SHaglund MMDobbins JOjemann GA: Low-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg 79:62691993

    • Search Google Scholar
    • Export Citation
  • 6

    Cascino GD: When drugs and surgery don't work. Epilepsia 49:Suppl 979842008

  • 7

    Cataltepe OTuranli GYalnizoglu DTopçu MAkalan N: Surgical management of temporal lobe tumor-related epilepsy in children. J Neurosurg 102:3 Suppl2802872005

    • Search Google Scholar
    • Export Citation
  • 8

    Chang EFPotts MBKeles GELamborn KRChang SMBarbaro NM: Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg 108:2272352008

    • Search Google Scholar
    • Export Citation
  • 9

    Choi JYChang JWPark YGKim TSLee BIChung SS: A retrospective study of the clinical outcomes and significant variables in the surgical treatment of temporal lobe tumor associated with intractable seizures. Stereotact Funct Neurosurg 82:35422004

    • Search Google Scholar
    • Export Citation
  • 10

    Cramer JAMintzer SWheless JMattson RH: Adverse effects of antiepileptic drugs: a brief overview of important issues. Expert Rev Neurother 10:8858912010

    • Search Google Scholar
    • Export Citation
  • 11

    Duffau H: Surgery of low-grade gliomas: towards a ‘functional neurooncology’. Curr Opin Oncol 21:5435492009

  • 12

    Duffau HCapelle LLopes MBitar ASichez JPvan Effenterre R: Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy. Acta Neurochir (Wien) 144:5635732002

    • Search Google Scholar
    • Export Citation
  • 13

    Eadie MJ: Unilateral motor epileptic seizures. J Clin Neurosci 2:36391995

  • 14

    Engel J JrVan Ness PCRasmussen TBOjemann LMOutcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies ed 2New YorkRaven Press1993. 609621

    • Search Google Scholar
    • Export Citation
  • 15

    Englot DJBlumenfeld H: Consciousness and epilepsy: why are complex-partial seizures complex?. Prog Brain Res 177:1471702009

  • 16

    Fried IKim JHSpencer DD: Limbic and neocortical gliomas associated with intractable seizures: a distinct clinicopathological group. Neurosurgery 34:8158241994

    • Search Google Scholar
    • Export Citation
  • 17

    Giulioni MRubboli GMarucci GMartinoni MVolpi LMichelucci R: Seizure outcome of epilepsy surgery in focal epilepsies associated with temporomesial glioneuronal tumors: lesionectomy compared with tailored resection. Clinical article. J Neurosurg 111:127512822009

    • Search Google Scholar
    • Export Citation
  • 18

    Hughlings-Jackson J: Localised convulsions from tumour of the brain. Brain 5:3643741882

  • 19

    Jooma RYeh HSPrivitera MDGartner M: Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures. J Neurosurg 83:2312361995

    • Search Google Scholar
    • Export Citation
  • 20

    Kim SKWang KCCho BK: Intractable seizures associated with brain tumor in childhood: lesionectomy and seizure outcome. Childs Nerv Syst 11:6346381995

    • Search Google Scholar
    • Export Citation
  • 21

    Kleihues PBurger PCScheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:2552681993

  • 22

    Klein MEngelberts NHvan der Ploeg HMKasteleijn-Nolst Trenité DGAaronson NKTaphoorn MJ: Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54:5145202003

    • Search Google Scholar
    • Export Citation
  • 23

    Lombardi DMarsh Rde Tribolet N: Low grade glioma in intractable epilepsy: lesionectomy versus epilepsy surgery. Acta Neurochir Suppl (Wien) 68:70741997

    • Search Google Scholar
    • Export Citation
  • 24

    Luyken CBlümcke IFimmers RUrbach HElger CEWiestler OD: The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44:8228302003

    • Search Google Scholar
    • Export Citation
  • 25

    Packer RJSutton LNPatel KMDuhaime ACSchiff SWeinstein SR: Seizure control following tumor surgery for childhood cortical low-grade gliomas. J Neurosurg 80:99810031994

    • Search Google Scholar
    • Export Citation
  • 26

    Panda SRadhakrishnan VVRadhakrishnan KRao RMSarma SP: Electro-clinical characteristics and postoperative outcome of medically refractory tumoral temporal lobe epilepsy. Neurol India 53:66722005

    • Search Google Scholar
    • Export Citation
  • 27

    Roper SN: Surgical treatment of the extratemporal epilepsies. Epilepsia 50:Suppl 869742009

  • 28

    Sheth RD: Adolescent issues in epilepsy. J Child Neurol 17:Suppl 22S232S272002

  • 29

    Taphoorn MJ: Neurocognitive sequelae in the treatment of lowgrade gliomas. Semin Oncol 30:6 Suppl 1945482003

  • 30

    Taphoorn MJKlein M: Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3:1591682004

  • 31

    Tran TASpencer SSJavidan MPacia SMarks DSpencer DD: Significance of spikes recorded on intraoperative electrocorticography in patients with brain tumor and epilepsy. Epilepsia 38:113211391997

    • Search Google Scholar
    • Export Citation
  • 32

    van Breemen MSWilms EBVecht CJ: Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6:4214302007

    • Search Google Scholar
    • Export Citation
  • 33

    Villanueva VCodina MElices E: Management of epilepsy in oncological patients. Neurologist 14:6 Suppl 1S44S542008

  • 34

    Wennberg RQuesney LFLozano AOlivier ARasmussen T: Role of electrocorticography at surgery for lesion-related frontal lobe epilepsy. Can J Neurol Sci 26:33391999

    • Search Google Scholar
    • Export Citation
  • 35

    White JCLiu CTMixter WJ: Focal epilepsy; a statistical study of its causes and the results of surgical treatment; epilepsy secondary to intracranial tumors. N Engl J Med 238:8918991948

    • Search Google Scholar
    • Export Citation
  • 36

    Yang LMorland TBSchmits KRawson ENarasimhan PMotelow JE: A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games. Epilepsy Behav 18:2382462010

    • Search Google Scholar
    • Export Citation
  • 37

    Zaatreh MMFirlik KSSpencer DDSpencer SS: Temporal lobe tumoral epilepsy: characteristics and predictors of surgical outcome. Neurology 61:6366412003

    • Search Google Scholar
    • Export Citation
  • 38

    Zentner JHufnagel AWolf HKOstertun BBehrens ECampos MG: Surgical treatment of neoplasms associated with medically intractable epilepsy. Neurosurgery 41:3783871997

    • Search Google Scholar
    • Export Citation
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