Predictors for Surgical Outcome in Patients with Tumor-Associated Epilepsy

Document Type : Original Article (s)

Authors

1 Associate Professor, Isfahan Neurosciences Research Center AND Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Isfahan Neurosciences Research Center AND Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Isfahan Neurosciences Research Center AND Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Departments of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 Professor, Behavioral Sciences Research Center AND Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

6 Professor, Isfahan Neurosciences Research Center AND Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Iran

7 Professor, Isfahan Neurosciences Research Center AND Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan Iran

8 Student of Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran

Abstract

Background: This study aimed to evaluate possible predictors for postoperative outcome in patients with tumor-associated epilepsy.Methods: In this study, patients with tumor-associated epilepsy who were candidates for epilepsy surgery were included. After required presurgical evaluations, they underwent surgical resection of the tumor. Patients were followed 24-57 months after the surgery and were divided to two groups of seizure-free and not-seizure-free. Demographic data, medical history, seizure characteristics and tumor features were compared between the two groups to find possible predictors.Findings: Thirty-five patients (17 men and 18 women) with the mean age of 22.8 years (8 to 45 years) were enrolled this study. Most of the patients had temporal lobe tumors (68.0%) followed by frontal and parietal lobe tumors. Ganglioglioma was seen in 62.9% of the patients, followed by astrocytoma and dysembryoplastic neuroepithelial tumour (DNET). We found a non-significant positive correlation between better surgical outcome and being male, younger age at epilepsy onset, longer duration of epilepsy, more seizure frequency, tumors in right hemisphere, tumor type of ganglioglioma, and seizures with secondary generalization. Furthermore, we found that history of head trauma, infection of centeral nervous system (CNS), febrile convulsion, natural vaginal delivery, familial history of epilepsy, tumors in temporal lobe, having auras, developing more seizure types and ipsilateral temporal spikes on preoperative electroencephalogram (EEG) were associated with worst surgical outcome (P > 0.05 for all).Conclusion: In this study, we found no statistically significant predicting factor for surgical outcome; however, we found that being male, smaller ages at seizure onset, longer duration of epilepsy, higher seizure frequency before surgery, involvement of right hemisphere, ganglioglioma, and secondary generalization are more seen in patients with better surgical outcome while history of head trauma, CNS infection, family history of epilepsy, temporal lobe tumors, presence of aura, having multiple types of seizures, and epileptic discharges from temporal lobe in preoperative EEG were seen more in patients with poor outcome. Studies with larger sample sizes are suggested to confirm these findings.

Keywords


  1. Bauer R, Dobesberger J, Unterhofer C, Unterberger I, Walser G, Bauer G, et al. Outcome of adult patients with temporal lobe tumours and medically refractory focal epilepsy. Acta Neurochir (Wien) 2007; 149(12): 1211-6.
  2. van Breemen MS, Vecht CJ. Optimal seizure management in brain tumor patients. Curr Neurol Neurosci Rep 2005; 5(3): 207-13.
  3. Vecht CJ, van Breemen M. Optimizing therapy of seizures in patients with brain tumors. Neurology 2006; 67(12 Suppl 4): S10-S13.
  4. Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir (Wien) 2000; 142(1): 1-15.
  5. van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 2007; 6(5): 421-30.
  6. Ruda R, Soffietti R. What is new in the management of epilepsy in gliomas? Curr Treat Options Neurol 2015; 17(6): 351.
  7. Brogna C, Gil RS, Duffau H. Brain tumors and epilepsy. Expert Rev Neurother 2008; 8(6): 941-55.
  8. Lynam LM, Lyons MK, Drazkowski JF, Sirven JI, Noe KH, Zimmerman RS, et al. Frequency of seizures in patients with newly diagnosed brain tumors: a retrospective review. Clin Neurol Neurosurg 2007; 109(7): 634-8.
  9. Dupont S. [Epilepsy and brain tumors]. Rev Neurol (Paris) 2008; 164(6-7): 517-22.
  10. Giulioni M, Marucci G, Martinoni M, Marliani AF, Toni F, Bartiromo F, et al. Epilepsy associated tumors: Review article. World J Clin Cases 2014; 2(11): 623-41.
  11. Guerrini R, Rosati A, Giordano F, Genitori L, Barba C. The medical and surgical treatment of tumoral seizures: current and future perspectives. Epilepsia 2013; 54(Suppl 9): 84-90.
  12. Consales A, Nozza P, Zoli ML, Morana G, Cama A. Glioneuronal tumors and epilepsy: clinico-diagnostic features and surgical strategies. In: Striano P, editor. Epilepsy towards the next decade: new trends and hopes in epileptology. New York, NY: Springer International Publishing; 2015. p. 47-70.
  13. Hennessy MJ, Elwes RD, Honavar M, Rabe-Hesketh S, Binnie CD, Polkey CE. Predictors of outcome and pathological considerations in the surgical treatment of intractable epilepsy associated with temporal lobe lesions. J Neurol Neurosurg Psychiatry 2001; 70(4): 450-8.
  14. Jehi LE, O'Dwyer R, Najm I, Alexopoulos A, Bingaman W. A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery. Epilepsia 2009; 50(9): 2040-52.
  15. Zaatreh MM, Spencer DD, Thompson JL, Blumenfeld H, Novotny EJ, Mattson RH, et al. Frontal lobe tumoral epilepsy: clinical, neurophysiologic features and predictors of surgical outcome. Epilepsia 2002; 43(7): 727-33.
  16. Boesebeck F, Janszky J, Kellinghaus C, May T, Ebner A. Presurgical seizure frequency and tumoral etiology predict the outcome after extratemporal epilepsy surgery. J Neurol 2007; 254(8): 996-9.
  17. Luyken C, Blumcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, et al. The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 2003; 44(6): 822-30.
  18. Englot DJ, Berger MS, Barbaro NM, Chang EF. Factors associated with seizure freedom in the surgical resection of glioneuronal tumors. Epilepsia 2012; 53(1): 51-7.
  19. Englot DJ, Berger MS, Barbaro NM, Chang EF. Predictors of seizure freedom after resection of supratentorial low-grade gliomas. A review. J Neurosurg 2011; 115(2): 240-4.
  20. Pallud J, Audureau E, Blonski M, Sanai N, Bauchet L, Fontaine D, et al. Epileptic seizures in diffuse low-grade gliomas in adults. Brain 2014; 137(Pt 2): 449-62.
  21. Engel J, Jr. Seizures and epilepsy. New York, NY: Oxford University Press; 2013.
  22. Chang EF, Potts MB, Keles GE, Lamborn KR, Chang SM, Barbaro NM, et al. Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg 2008; 108(2): 227-35.
  23. Bourgeois M, Sainte-Rose C, Lellouch-Tubiana A, Malucci C, Brunelle F, Maixner W, et al. Surgery of epilepsy associated with focal lesions in childhood. J Neurosurg 1999; 90(5): 833-42.
  24. Jorge CL, Nagahashi-Marie SK, Pedreira CC, Rosemberg S, Valerio RM, Valente KD, et al. Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy. Arq Neuropsiquiatr 2000; 58(4): 1002-8.
  25. Zentner J, Hufnagel A, Wolf HK, Ostertun B, Behrens E, Campos MG, et al. Surgical treatment of neoplasms associated with medically intractable epilepsy. Neurosurgery 1997; 41(2): 378-86.
  26. Frater JL, Prayson RA, Morris III HH, Bingaman WE. Surgical pathologic findings of extratemporal-based intractable epilepsy: a study of 133 consecutive resections. Arch Pathol Lab Med. 2000; 124(4): 545-9.
  27. Fois C, Kovac S, Khalil A, Uzuner GT, Diehl B, Wehner T, et al. Predictors for being offered epilepsy surgery: 5-year experience of a tertiary referral centre. J Neurol Neurosurg Psychiatry 2016; 87(2): 209-11.
  28. Park YS, Kim DS, Shim KW, Kim JH, Choi JU. Factors contributing to resectability and seizure outcomes in 44 patients with ganglioglioma. Clin Neurol Neurosurg 2008; 110(7): 667-73.
  29. Zaatreh MM, Firlik KS, Spencer DD, Spencer SS. Temporal lobe tumoral epilepsy: characteristics and predictors of surgical outcome. Neurology 2003; 61(5): 636-41.
  30. Tonini C, Beghi E, Berg AT, Bogliun G, Giordano L, Newton RW, et al. Predictors of epilepsy surgery outcome: a meta-analysis. Epilepsy Res 2004; 62(1): 75-87.
  31. Morris HH, Matkovic Z, Estes ML, Prayson RA, Comair YG, Turnbull J, et al. Ganglioglioma and intractable epilepsy: clinical and neurophysiologic features and predictors of outcome after surgery. Epilepsia 1998; 39(3): 307-13.
  32. Lhatoo SD, Moghimi N, Schuele S. Tumor-related epilepsy and epilepsy surgery. Epilepsia 2013; 54(Suppl 9): 1-4.