Seizure characteristics and control following resection in 332 patients with low-grade gliomas

Edward F. Chang, Matthew B. Potts, G. Evren Keles, Kathleen R. Lamborn, Susan M. Chang, Nicholas Barbaro, Mitchel S. Berger

Research output: Contribution to journalArticle

314 Citations (Scopus)

Abstract

Object. Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. Methods. The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. Results. Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with ≥ 1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively (p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer (p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history (p <0.001) and simple partial seizures (p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2-124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression (p = 0.001). Conclusions. The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.

Original languageEnglish (US)
Pages (from-to)227-235
Number of pages9
JournalJournal of Neurosurgery
Volume108
Issue number2
DOIs
StatePublished - Feb 2008
Externally publishedYes

Fingerprint

Glioma
Seizures
Multivariate Analysis
Oligodendroglioma
San Francisco
Astrocytoma
Temporal Lobe

Keywords

  • Brain tumor
  • Engel class
  • Epilepsy
  • Extent of resection
  • Low-grade glioma
  • Seizure

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Chang, E. F., Potts, M. B., Keles, G. E., Lamborn, K. R., Chang, S. M., Barbaro, N., & Berger, M. S. (2008). Seizure characteristics and control following resection in 332 patients with low-grade gliomas. Journal of Neurosurgery, 108(2), 227-235. https://doi.org/10.3171/JNS/2008/108/2/0227

Seizure characteristics and control following resection in 332 patients with low-grade gliomas. / Chang, Edward F.; Potts, Matthew B.; Keles, G. Evren; Lamborn, Kathleen R.; Chang, Susan M.; Barbaro, Nicholas; Berger, Mitchel S.

In: Journal of Neurosurgery, Vol. 108, No. 2, 02.2008, p. 227-235.

Research output: Contribution to journalArticle

Chang, EF, Potts, MB, Keles, GE, Lamborn, KR, Chang, SM, Barbaro, N & Berger, MS 2008, 'Seizure characteristics and control following resection in 332 patients with low-grade gliomas', Journal of Neurosurgery, vol. 108, no. 2, pp. 227-235. https://doi.org/10.3171/JNS/2008/108/2/0227
Chang, Edward F. ; Potts, Matthew B. ; Keles, G. Evren ; Lamborn, Kathleen R. ; Chang, Susan M. ; Barbaro, Nicholas ; Berger, Mitchel S. / Seizure characteristics and control following resection in 332 patients with low-grade gliomas. In: Journal of Neurosurgery. 2008 ; Vol. 108, No. 2. pp. 227-235.
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abstract = "Object. Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. Methods. The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. Results. Three hundred and thirty-two cases were included for analysis; 269 (81{\%}) of the 332 patients presented with ≥ 1 seizures (generalized alone, 33{\%}; complex partial alone, 16{\%}; simple partial alone, 22{\%}; and combination, 29{\%}). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively (p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49{\%}) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer (p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67{\%}; rare seizures (II), 17{\%}; meaningful seizure improvement (III), 8{\%}; and no improvement or worsening (IV), 9{\%}. Poor seizure control was more common in patients with longer seizure history (p <0.001) and simple partial seizures (p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95{\%} confidence interval 2.2-124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression (p = 0.001). Conclusions. The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90{\%} of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.",
keywords = "Brain tumor, Engel class, Epilepsy, Extent of resection, Low-grade glioma, Seizure",
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AU - Chang, Edward F.

AU - Potts, Matthew B.

AU - Keles, G. Evren

AU - Lamborn, Kathleen R.

AU - Chang, Susan M.

AU - Barbaro, Nicholas

AU - Berger, Mitchel S.

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N2 - Object. Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. Methods. The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. Results. Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with ≥ 1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively (p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer (p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history (p <0.001) and simple partial seizures (p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2-124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression (p = 0.001). Conclusions. The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.

AB - Object. Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. Methods. The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. Results. Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with ≥ 1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively (p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer (p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history (p <0.001) and simple partial seizures (p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2-124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression (p = 0.001). Conclusions. The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.

KW - Brain tumor

KW - Engel class

KW - Epilepsy

KW - Extent of resection

KW - Low-grade glioma

KW - Seizure

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