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.