title: Seizures during the management of high-grade gliomas: clinical relevance to disease progression.
abstract: This study was performed to evaluate the incidence of seizures with its implications on disease progression and the diagnostic value of post-ictal magnetic resonance images (MRI) during the management of high-grade gliomas (HGGs). A total of 406 consecutive patients with newly diagnosed HGGs were retrospectively reviewed. The incidence of seizures during the management was investigated. In patients who experienced a seizure, the causality between seizures and disease progression was assessed by pre-ictal, post-ictal (<1 month), and follow-up (<3 months) MRI. After a median follow-up of 17.4 months (range 0.1-88.3), seizures developed in 127 patients (31 %). Of the 127 patients, radiological progression at the post-ictal MRI was found in 83 patients (65 %) and the follow-up MRI confirmed progression in 79 patients (62 %). Four other patients (3 %) were shown to be progression-free. Among those without radiological progression at the post-ictal MRI, the follow-up MRI confirmed progression-free in 31 patients (24 %); however, 13 patients (10 %) revealed eventual progression. In the patients with a seizure, absence of preoperative seizures (p = 0.003), <95 % tumor resection (p = 0.001), and pre-ictal Karnofsky Performance Scale score ≤ 70 (p = 0.025) were significantly associated with disease progression. During the management of HGG, 31 % of patients experienced seizures; of these patients, 72 % harbored progressive disease. The post-ictal MRI is useful for detecting disease progression; however, there are pitfalls. Clinical settings should be considered together for diagnosing disease progression in patients with seizures.
authors: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehang-ro Jongno-gu, Seoul 110-744, South Korea.
authors: Young-Hoon
authors: YH
authors: Kim
authors: Chul-Kee
authors: CK
authors: Park
authors: Tae Min
authors: TM
authors: Kim
authors: Seung Hong
authors: SH
authors: Choi
authors: Yu Jung
authors: YJ
authors: Kim
authors: Byung Se
authors: BS
authors: Choi
authors: Jung Ho
authors: JH
authors: Han
authors: Se-Hoon
authors: SH
authors: Lee
authors: Chae-Yong
authors: CY
authors: Kim
authors: In Ah
authors: IA
authors: Kim
authors: Dae Seog
authors: DS
authors: Heo
authors: Il Han
authors: IH
authors: Kim
authors: Dong Gyu
authors: DG
authors: Kim
authors: Hee-Won
authors: HW
authors: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000150:complications* / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult