title: Seizure reduction in a low-grade glioma: more than a beneficial side effect of temozolomide.
abstract: BACKGROUND
  Seizures are a common symptom in patients with low-grade glioma (LGG), negatively influencing quality of life, if uncontrolled. Besides antiepileptic drugs, antitumour treatment might contribute to a reduction in seizure frequency. The aim of this study was to determine the effect of temozolomide (TMZ) chemotherapy on seizure frequency, to identify factors associated with post-treatment seizure reduction and to analyse the prognostic value of seizure reduction for survival.
  
  
  METHODS
  We retrospectively reviewed adult patients with supratentorial LGG and epilepsy who received chemotherapy with TMZ as initial treatment or for progressive disease in two hospitals (VUmc Amsterdam; MCH The Hague) between 2002 and 2012.
  
  
  RESULTS
  We identified 104 patients with LGG with epilepsy who had received TMZ. Uncontrolled epilepsy in the 3 months preceding chemotherapy was present in 66 of 104 (63.5%) patients. A ≥ 50% reduction in seizure frequency after 6 months occurred in 29 of 66 (43.9%) patients. Focal symptoms at presentation (OR 6.55; 95% CI 1.45 to 32.77; p = 0.015) appeared to be positively associated with seizure reduction. Seizure reduction was an independent prognostic factor for progression-free survival (HR 0.32; 95% CI 0.15 to 0.66; p = 0.002) and overall survival (HR 0.33; 95% CI 0.14 to 0.79; p = 0.013), along with a histological diagnosis of oligodendroglioma (HR 0.38; 95% CI 0.17 to 0.86; p = 0.021). Objective responses on MRI were similar for patients with and without seizure reduction.
  
  
  CONCLUSIONS
  TMZ may contribute to an important reduction in seizure frequency in patients with LGG. Seizure reduction following TMZ treatment has prognostic significance and may serve as an important clinical outcome measure in patients with LGG.
authors: Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands.
authors: Johan A F
authors: JA
authors: Koekkoek
authors: Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Linda
authors: L
authors: Dirven
authors: Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Jan J
authors: JJ
authors: Heimans
authors: Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Tjeerd J
authors: TJ
authors: Postma
authors: Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands.
authors: Maaike J
authors: MJ
authors: Vos
authors: Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Jaap C
authors: JC
authors: Reijneveld
authors: Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands.
authors: Martin J B
authors: MJ
authors: Taphoorn
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000150:complications* / Q000188:drug therapy*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D023381:Endpoint Determination; D005260:Female; D005910:Glioma / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012640:Seizures / Q000188:drug therapy* / Q000209:etiology*; D016019:Survival Analysis; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Clinical Neurology; Epilepsy; Tumours