title: Predictors of preoperative and early postoperative seizures in patients with intra-axial primary and metastatic brain tumors: A retrospective observational single center study.
abstract: OBJECTIVE
  Antiepileptic treatment of brain tumor patients mainly depends on the individual physician's choice rather than on well-defined predictive factors. We investigated the predictive value of defined clinical parameters to formulate a model of risk estimations for subpopulations of brain tumor patients.
  
  
  METHODS
  We enclosed 650 patients > 18 years of age who underwent brain tumor surgery and included a number of clinical data. Logistic regressions were performed to determine the effect sizes of seizure-related risk factors and to develop prognostic scores for the occurrence of preoperative and early postoperative seizures.
  
  
  RESULTS
  A total of 492 patients (334 gliomas) were eligible for logistic regression for preoperative seizures, and 338 patients for early postoperative seizures. Age ≤ 60 years (odds ratio [OR] = 1.66, p = 0.020), grades I and II glioma (OR = 4.00, p = 0.0002), total tumor/edema volume ≤ 64cm(3) (OR = 2.18, p = 0.0003), and frontal location (OR = 2.28, p = 0.034) demonstrated an increased risk for preoperative seizures. Isocitrate-dehydrogenase mutations (OR = 2.52, p = 0.026) were an independent risk factor in the glioma subgroup. Age ≥ 60 years (OR = 3.32, p = 0.041), total tumor/edema volume ≤ 64cm(3) (OR = 3.17, p = 0.034), complete resection (OR = 15.50, p = 0.0009), diencephalic location (OR = 12.2, p = 0.013), and high-grade tumors (OR = 5.67, p = 0.013) were significant risk factors for surgery-related seizures. Antiepileptics (OR = 1.20, p = 0.60) did not affect seizure occurrence. For seizure occurrence, patients could be stratified into 3 prognostic preoperative and into 2 prognostic early postoperative groups.
  
  
  CONCLUSIONS
  Based on the developed prognostic scores, seizure prophylaxis should be considered in high-risk patients and patient stratification for prospective studies may be feasible in the future.
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.|Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Skardelly
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.
authors.forename: Elina
authors.initials: E
authors.lastname: Brendle
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.|Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.
authors.forename: Susan
authors.initials: S
authors.lastname: Noell
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.|Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Behling
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.|Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.|Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Wuttke
authors.affiliation: Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.|Institute of Pathology and Neuropathology, Division of Neuropathology, University Hospital Tübingen, Eberhard Karls University Tübingen.
authors.forename: Jens
authors.initials: J
authors.lastname: Schittenhelm
authors.affiliation: Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.|Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University Tübingen.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Bisdas
authors.affiliation: Institute of Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Eberhard Karls University Tübingen.
authors.forename: Christoph
authors.initials: C
authors.lastname: Meisner
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rona
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.|Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.
authors.forename: Marcos Soares
authors.initials: MS
authors.lastname: Tatagiba
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University Tübingen.|Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tüebingen, Eberhard Karls University of Tüebingen, Hoppe-Seyler-Straße, 3, 72076, Tübingen, Germany.|Interdisciplinary Division of Neuro-Oncology, Departments of Vascular Neurology and Neurosurgery, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen.|German Cancer Consortium (DKTK), DKFZ partner site Tüebingen, Tüebingen, Germany.|Center for Personalized Medicine, Eberhard Karls University of Tüebingen, Tüebingen, Germany.
authors.forename: Ghazaleh
authors.initials: G
authors.lastname: Tabatabai
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D005910:Glioma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000209:etiology*