Postoperative seizure control in patients with tumor-associated epilepsy.
The patterns of postoperative seizure control and response to antiepileptic drugs (AEDs) in tumor-associated epilepsy (TAE) are poorly understood. We aim to document these characteristics in patients with supratentorial gliomas.



This was a retrospective analysis of 186 patients with supratentorial gliomas. Seizure patterns were classified into four groups: A, no postoperative seizure; B, early postoperative seizure control within 6 months; C, fluctuating seizure control; and D, never seizure-free. Rates and duration of seizure freedom, subsequent seizure relapse, and response to AED were analyzed.



Among patients included, 49 (26.3%) had grade II, 28 (15.1%) had grade III, and 109 (58.6%) had grade IV glioma. Outcome pattern A was observed in 95 (51.1%), B in 22 (11.8%), C in 45 (24.2%), and D in 24 (12.9%). One hundred nineteen patients had at least one seizure and were classified as having TAE. Compared to pattern A, pattern B was predicted by histologic progression; pattern C by tumor grade, preoperative seizure, and histologic progression, and pattern D by preoperative seizure and gross total resection. Among patients with TAE, 57.5% of grade II, 68.2% of grade III, and 26.3% of grade IV experienced a period of 12-month seizure freedom. After first 12-month seizure remission, 39.1%, 60.0%, and 13.3% of grade II, III, and IV gliomas, respectively, experienced subsequent seizure; 22.6% of those with TAE reached terminal seizure freedom of at least 12 months on their first postoperative AED regimen, 6.5% on their second regimen, and 5.4% on subsequent regimens.



Distinct patterns of postoperative seizure control exist in gliomas; they have specific risk factor profiles, and we hypothesize these correspond to unique pathogenic mechanisms. Twelve-month seizure freedom with subsequent relapse is frequent in grade II-III gliomas. Response to AEDs is markedly poorer than with non-TAE, highlighting the complex epileptogenicity of gliomas.
Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.|Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Andrew
A
Neal
Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.|Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Andrew
A
Morokoff
Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.|Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Terence John
TJ
O'Brien
Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.|Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Patrick
P
Kwan
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000601:surgery; D015331:Cohort Studies; D004827:Epilepsy / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome
D000927:Anticonvulsants
Epilepsy; Glioma; Seizure; Tumor