Epilepsy Surgery Outcomes in Patients with Drug-Resistant Forms with Low-Grade Tumors
DOI:
https://doi.org/10.36552/pjns.v28i4.1014Abstract
Objective: To evaluate the efficacy of neurosurgical treatment of patients with drug-resistant structural epilepsy caused by low-grade brain tumors.
Materials and Methods: 30 patients with drug-resistant structural epilepsy caused by low-grade tumors. Preoperative evaluation and surgical treatment were performed from 01.01.2016 to 31.12.2023. As a preoperative evaluation, all patients underwent neurological and neuropsychological examination, the semiology of seizures was assessed, and neuroimaging and neurophysiological studies were performed. A histological examination of resected brain areas was performed. Surgical outcome assessed by J. Engel Surgical Treatment Outcome Scale (1993) at 12, 24 months.
Results: 30 patients were treated surgically, 10 (33%) were men and 20 (67%) – women. The mean age of the patients was 29.76 years. Focal motor and non-motor seizures were noted in 12 (40%) patients. 18 (60%) patients had bilateral tonic-clonic seizures with focal onset. All 30 patients underwent resection surgery: 10 patients (33%) underwent anterior mesial temporal lobectomy (AMTLE) , 17 patients (57%) – lesionectomy, 2 – AMTLE plus lesionectomy, and one – lesionectomy plus selective amygdalohippocampectomy (SAH). The results of surgical treatment 12 months after surgery were evaluated in 25 patients. Engel I outcomes after 12 months were in 18 patients (72%), at 24 months in - 73%.
Conclusion: The results of our study demonstrate the efficacy of surgical treatment in patients with drug-resistant structural epilepsy caused by low-grade brain tumors. Significant improvement in seizure control was seen in the Engel I results at 12 and 24 months after surgery (72% and 73%, respectively
References
Olafsson E, Ludvigsson P, Hesdorffer D, Kjartansson O, Hauser WA, Gudmundsson G. Incidence of unprovoked seizures and epilepsy in Iceland and assessment of the epilepsy syndrome classification: a prospective study. The Lancet Neurology [Internet]. 2005 Oct 1 [cited 2020 Mar 9];4(10):627–34. https://doi.org/10.1016/s1474-4422(05)70172-1
Bromfield EB. Epilepsy in patients with brain tumors and other cancers. Rev Neurol Dis. 2004;1 Suppl 1:S27-33. PMID: 16400292.
Syvertsen M, Nakken KO, Edland A, Hansen G, Hellum MK, Koht J. Prevalence and etiology of epilepsy in a Norwegian county-A population based study. Epilepsia. 2015 Mar 25;56(5):699–706. https://doi.org/10.1111/epi.12972
van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. The Lancet Neurology. 2007 May;6(5):421–30. https://doi.org/10.1016/S1474-4422(07)70103-5
Cowie CJA, Cunningham MO. Peritumoral epilepsy: Relating form and function for surgical success. Epilepsy & Behavior. 2014 Sep;38:53–61. https://doi.org/10.1016/j.yebeh.2014.05.009
Zelano J, Klecki J, Christensen J, Tomson T, Malmgren K. The provision of epilepsy care across Europe 2017: A 17-year follow-up survey. Epilepsia Open. 2019 Feb 15;4(1):144–52. https://doi.org/10.1002/epi4.12306
Klein M, Engelberts NHJ, van der Ploeg HM, Kasteleijn-Nolst Trenité DGA, Aaronson NK, Taphoorn MJB, et al. Epilepsy in low-grade gliomas: The impact on cognitive function and quality of life. Annals of Neurology. 2003 Sep 19;54(4):514–20. https://doi.org/10.1002/ana.10712
Luyken C, Blümcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, et al. The Spectrum of Long-term Epilepsy-associated Tumors: Long-term Seizure and Tumor Outcome and Neurosurgical Aspects. Epilepsia. 2003 Jun 9;44(6):822–30. https://doi.org/10.1046/j.1528-1157.2003.56102.x
Wetjen NM, Cascino GD. Resective surgery of neoplasms. 2015 Oct 2;842–57.
Hughlings-Jackson j. Localised convulsions from tumour of the brain. Brain. 1882;5(3):364–74. https://doi.org/10.1093/brain/awr241
Ketz E. Brain tumours and epilepsy. In: Vinken PJ, Bruyn GW editor(s). Handbook of Clinical Neurology. Vol. 16, Amsterdam: North?Holland Publishing Company, 1974:254?69.
Penfield W. Relation of intracranial tumors and symptomatic epilepsy. Archives of neurology and psychiatry. 1940 aug 1;44(2):300. doi:10.1001/archneurpsyc.1940.02280080060002
Echlin FA, Peck D, Schmer C, Brown LM. The supersensitivity of chronically “isolated” cerebral cortex as a mechanism in focal epilepsy. Electroencephalography and Clinical Neurophysiology. 1959 Nov 1;11(4):697–722. https://doi.org/10.1016/0013-4694(59)90110-5.
You G, Sha ZY ., Yan W, Zhang W, Wang YZ ., Li SW ., et al. Seizure characteristics and outcomes in 508 Chinese adult patients undergoing primary resection of low-grade gliomas: a clinicopathological study. Neuro-Oncology. 2011 Dec 19;14(2):230–41. https://doi.org/10.1093/neuonc/nor205
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Copyright (c) 2024 Oleg Levchenko, Igor Trifonov, Mikhail Sinkin, Ayna Shakhmanayeva, Anastasya SkalnayaThe work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).