Glioma-related epilepsy in patients with diffuse high-grade glioma after the 2016 WHO update: seizure characteristics, risk factors, and clinical outcomes

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  • 1 Beijing Neurosurgical Institute, Capital Medical University;
  • | 2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
  • | 3 Research Units of Accurate Diagnosis and Treatment of Brain Tumors and Translational Medicine, Chinese Academy of Medical Sciences, Beijing, China
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OBJECTIVE

The aim of this study was to investigate the epidemiological characteristics, associated risk factors, and prognostic value of glioma-related epilepsy in patients with diffuse high-grade gliomas (DHGGs) that were diagnosed after the 2016 updated WHO classification was released.

METHODS

Data from 449 patients with DHGGs were retrospectively collected. Definitive diagnosis was reaffirmed according to the 2016 WHO classification. Seizure outcome was assessed using the Engel classification at 12 months after surgery. Univariate and multivariate analyses were performed to identify risk factors associated with preoperative and postoperative glioma-related epilepsy. Lastly, the prognostic value of glioma-related epilepsy was evaluated by Kaplan-Meier and Cox analysis.

RESULTS

The incidence of glioma-related epilepsy decreased gradually as the malignancy of the tumor increased. Age < 45 years (OR 2.601, p < 0.001), normal neurological function (OR 3.024, p < 0.001), and lower WHO grade (OR 2.028, p = 0.010) were independently associated with preoperative glioma-related epilepsy, while preoperative glioma-related epilepsy (OR 7.554, p < 0.001), temporal lobe involvement (OR 1.954, p = 0.033), non–gross-total resection (OR 2.286, p = 0.012), and lower WHO grade (OR 2.130, p = 0.021) were identified as independent predictors of poor seizure outcome. Furthermore, postoperative glioma-related epilepsy, rather than preoperative glioma-related epilepsy, was demonstrated as an independent prognostic factor for overall survival (OR 0.610, p = 0.010).

CONCLUSIONS

The updated WHO classification seems conducive to reveal the distribution of glioma-related epilepsy in DHGG patients. For DHGG patients with high-risk predictors of poor seizure control, timely antiepileptic interventions could be beneficial. Moreover, glioma-related epilepsy (especially postoperative glioma-related epilepsy) is associated with favorable overall survival.

ABBREVIATIONS

AA = anaplastic astrocytoma; AED = antiepileptic drug; AO = anaplastic oligodendroglioma; DHGG = diffuse high-grade glioma; DLGG = diffuse low-grade glioma; EOR = extent of resection; GBM = glioblastoma; GTR = gross-total resection; IDH = isocitrate dehydrogenase; OS = overall survival; PFS = progression-free survival; wt = wild type.

Illustration from Schneider et al. (pp 205–214). Copyright Elyssa Siegel. Published with permission.

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