title: Epileptic features and survival in glioblastomas presenting with seizures.
abstract: The prognostic value of seizures in patients with glioblastoma is currently under discussion. The objective of this research was to study the risk factors associated with seizures occurring at the diagnosis of glioblastoma and the role of seizures as a predictive factor for survival.
  
  
  
  We prospectively analyzed the clinical data over the course of the disease, baseline MR imaging, and histological characteristics (p53 overexpression, the Ki67 proliferation index, and presence of the IDH1 R132H mutation), in glioblastomas treated in a single hospital from November 2012 to July 2014. The study follow-up cutoff point was October 2015.
  
  
  
  In total, 56 patients were recruited (57% men, mean age 57 years). Median baseline score on the Karnofsky performance scale was 80. Complete tumor debulking followed by radiochemotherapy was achieved in 58.9%. Mean survival was 13.6 months. Epileptic seizures were the presenting symptom in 26.6% of patients, and 44.6% experienced seizures at some point during the course of the disease. On multivariate analysis, the single factor predicting shorter survival was age older than 60 years (hazard ratio 3.565 (95%CI, 1.491-8.522), p=0.004). Seizures were associated with longer survival only in patients younger than 60 years (p=0.035). Younger age, the IDH1 R132H mutation, and p53 overexpression (>40%) were related to seizures at presentation. Baseline MRI findings, including tumor size, and the Ki67 proliferation index were not associated with the risk of epileptic seizures or with survival. Prophylactic antiepileptic drugs did not increase survival time.
  
  
  
  Seizures as the presenting symptom of glioblastoma predicted longer survival in adults younger than 60 years. The IDH1 R132H mutation and p53 overexpression (>40%) were associated with seizures at presentation. Seizures showed no relationship with the tumor size or proliferation parameters.
authors.affiliation: Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. Electronic address: mtoledo@vhebron.net.
authors.forename: Manuel
authors.initials: M
authors.lastname: Toledo
authors.affiliation: MR Unit, Institut Diagnostic per la Imatge, Neuroradiology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Silvana
authors.initials: S
authors.lastname: Sarria-Estrada
authors.affiliation: Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana
authors.affiliation: Oncologic Radiotherapy Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Maldonado
authors.affiliation: Neurosurgery Department, Vall d́Hebron University Hospital,Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Martinez-Ricarte
authors.affiliation: Vall d́Hebron Oncology Institute, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rodon
authors.affiliation: MR Unit, Institut Diagnostic per la Imatge, Neuroradiology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Auger
authors.affiliation: Neuropathology Unit, Pathology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Miren
authors.initials: M
authors.lastname: Aizpurua
authors.affiliation: Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Salas-Puig
authors.affiliation: Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Estevo
authors.initials: E
authors.lastname: Santamarina
authors.affiliation: Neuropathology Unit, Pathology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Martinez-Saez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D001932:Brain Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007521:Isocitrate Dehydrogenase / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011446:Prospective Studies; D012640:Seizures / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
chemical_list: D016159:Tumor Suppressor Protein p53; D007521:Isocitrate Dehydrogenase; C543588:IDH1 protein, human
keywords: Antiepileptic drugs; Epilepsy; Glioblastoma; Idh; Primary brain tumor; Seizures