GLIOMA-RELATED EPILEPSY - CHARACTERISTICS AND IMPLICA-TIONS ON TREATMENT AND PROGNOSIS IN THE CONTEXT OF MOST RECENT BRAIN TUMOR MANAGEMENT GUIDELINES
Abstract
Diffuse low-grade gliomas, neoplasms originating from glial tissue, exhibit a propensity to evolve into tumors of a higher grade over time. The management of low-grade glioma presents a multifaceted challenge in clinical decision-making, given its complex diagnostic profile. Numerous factors have been identified as critical in determining the outcomes of various treatment modalities and in serving as prognostic indicators with predictive significance. Among these, glioma-associated epilepsy stands out as a principal clinical indicator, playing a pivotal role in both the management strategies and prognostication post-treatment. Materials and methods: A retrospective analysis was conducted on a cohort of 38 patients diagnosed with low-grade glioma (LGG), World Health Organization (WHO) grade 2 or 3, who were treated within our neurosurgical department from 2013 to 2023. This study primarily focused on the occurrence of glioma-related epileptic seizures. Additionally, an extensive review of the pertinent literature was undertaken to enrich the analysis. The evaluation encompassed the assessment of Engel outcomes six months following surgical resection, along with the examination of the anti-seizure medication (ASM) regimens implemented. Furthermore, a comprehensive review and synthesis of the current National Institute for Health and Care Excellence (NICE) guidelines pertaining to the management of low-grade gliomas were conducted, highlighting the latest recommendations and therapeutic strategies. Results: Within the cohort of 38 patients diagnosed with glioma, 30 were definitively identified as having diffuse astrocytoma (grade 2 and 3), while the remaining 8 were diagnosed with oligodendroglioma. Among those experiencing glioma-related epilepsy (n=25), a management approach involving biopsy only was applied to 8% (n=2) of the cases, gross total resection (GTR) was performed on 40% (n=10), subtotal resection (StR) was administered to 32% (n=8), and partial resection (PaR) was executed on 20% (n=5) of the patients. The investigation did not uncover a significant correlation between the occurrence of seizures and variables such as tumor volume, rate of growth, or histological findings. However, a notable positive effect of the extent of surgical resection on patient outcomes was observed, as measured by the Engel classification system, six months subsequent to oncological intervention. Discussion: Several researchers have illustrated that the presence of seizures during the initial stages serves as a favorable prognostic indicator for both malignant progression-free survival and overall survival in patients diagnosed with glioma. Furthermore, the manifestation of epilepsy as a presenting symptom significantly impacts the quality of life of individuals afflicted with glioma. Conclusions: Exploration into a more intricate approach to epilepsy surgery specifically targeting glioma-related seizures could yield considerable advantages, with the potential to enhance the quality of life for patients post-treatment.
References
2. Larsen J, Wharton SB, McKevitt F, et al. ‘Low grade glioma’: an update for radiologists. Br J Radiol 2017; 90(1070): 20160600.
3. NICE guidelines 2018 Brain tumours (primary) and brain metastases in adults: evidence reviews for the investigation, management and follow-up of glioma, July 2018.
4. Reese JC, Fadel HA, Pawloski JA, et al. Laser interstitial thermal therapy for deep-seated perivascular brain tumors is not associated with distal ischemia. J Neurooncol 2024; 166(2): 265-272.
5. Hawasli AH, Bagade S, Shimony JS, Miller-Thomas M, Leuthardt EC. Magnetic resonance imaging-guided focused laser interstitial thermal therapy for intracranial lesions: single-institution series. Neu-rosurgery. 2013; 73(6): 1007-1017.
6. Le VT, Nguyen AM, Pham TA, Nguyen PL. Tumor-related epilepsy and post-surgical outcomes: tertiary hospital experience in Vietnam. Sci Rep 2023; 13(1): 10859.
7. Engel Jr J, Van Ness PC, Rasmussen TB, Ojemann LM. Outcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies ed. 2 New York.
8. Tripathi S, Nathan CL, Tate MC, et al. The immune system and metabolic products in epilepsy and glioma-associated epilepsy: emerging therapeutic directions. JCI Insight 2024; 9(1): e174753.
9. Avila EK, Chamberlain M, Schiff D, et al. Seizure control as a new metric in assessing efficacy of tumor treatment in low-grade glioma trials. Neuro Oncol 2017; 19(1): 12-21.
10. de Groot M, Reijneveld JC, Aronica E, Heimans JJ. Epilepsy in patients with a brain tumor: focal epilepsy requires focused treatment. Brain 2012; 135(Pt 4): 1002-1016.
11. Senner V, Köhling R, Püttmann-Cyrus S, Straub H, Paulus W, Speckmann EJ. A new neurophysio-logical/neuropathological ex vivo model localizes the origin of glioma-associated epileptogenesis in the invasion area. Acta Neuropathol 2004; 107(1): 1-7.
12. Müller SJ, Khadhraoui E, Ganslandt O, Henkes H, Gihr GA. MRI Treatment Response Assessment Maps (TRAMs) for differentiating recurrent glioblastoma from radiation necrosis. J Neurooncol 2024; 166(3): 513-521.
13. Yu-Zhe Y, Xiao-Hong C, Han Y, et al. Application of Deep Learning on MRI for Discriminating Glioma Recurrence from Radiation Necrosis: Algorithm Development and Validation, 06 October 2023, (Version 1) available at Research Square / doi: 10.21203/rs.3.rs-3393301/v1.
14. Miculescu I, Ivan DL, Dabu A, Teleanu D, Ciurea AV. The T2FLAIR mismatch novel radiogenomic marker in the newly suspected low-grade gliomas: Implications for grading and neurosurgical man-agement in light of the 2021 WHO Classification of Tumours of the Central Nervous System (WHOCNS5). Romanian Neurosurgery 2023; 37(2): 141-149.
15. Ciurea AV, Iencean St. Actualitati in tumorile intracraniene, Bucuresti: Ed. Universitara, 2011, 31-35.
16. Onciul R, Brehar FM, Toader C, et al. Deciphering Glioblastoma: Fundamental and Novel Insights into the Biology and Therapeutic Strategies of Gliomas. Current Issues in Molecular Biology 2024; 46(3): 2402-2443.
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