Advertisement

Epilepsy in Diffuse Low-Grade Gliomas

  • Anja SmitsEmail author
Chapter

Abstract

Epileptic seizures occur in the majority of patients with diffuse low-grade glioma (DLGG) as initial symptoms leading to tumor diagnosis. The temporal relationship between seizures and diagnosis in DLGG is, however, not always easily defined; minor focal seizures may go unnoticed for many years, seizures may occur first after radiological diagnosis in previously asymptomatic patients, and, in rare cases, seizures can precede the diagnosis of brain tumor. The risk of developing tumor-related seizures is inversely correlated with the growth rate of the tumor, being highest for patients with slowly growing tumors. The specific location of the tumor and its proximity to the cortex are other important factors affecting seizure risk in patients with DLGG.

About half of all patients with DLGG continue to have seizures before operation, in spite of adequate antiepileptic drug treatment. Poor seizure control has a strong negative impact on the health-related quality of life in this patient group. Improved seizure control in patients with medically refractory epilepsy can be achieved by tumor resection including removal of seizure foci, either as single treatment or in combination with radiotherapy and chemotherapy. When studying the relationship between seizure control and clinical outcome of DLGG, the natural evolution of these tumors has to be considered. The presence of seizures as initial and exclusive symptom at diagnosis is a strong favorable prognostic factor. There is some evidence that preoperative seizure freedom in DLGG is an additional prognostic factor for longer survival. Recurrent seizures after an initial seizure-free period or late-onset seizures are frequently associated with malignant progression, but the exact temporal relationship between seizures and tumor progression in DLGG remains unclear.

Keywords

Epilepsy Seizure risk Seizure control Tumor control Survival Natural course 

References

  1. 1.
    Aronica E, Gorter JA, van Vliet EA, Spliet WG, van Veelen CW, van Rijen PC, et al. Overexpression of the human major vault protein in gangliogliomas. Epilepsia. 2003;44:1166–74.PubMedCrossRefGoogle Scholar
  2. 2.
    Aronica E, Boer K, Becker A, Redeker S, Spliet WG, van Rijen PC, et al. Gene expression profile analysis of epilepsy-associated gangliogliomas. Neuroscience. 2008;151:272–92.PubMedCrossRefGoogle Scholar
  3. 3.
    Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir (Wien). 2000;142:1–15.CrossRefGoogle Scholar
  4. 4.
    Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW, et al. Recommendations for a definition of acute symptomatic seizure. Epilepsia. 2010;51:671–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Berntsson SG, Malmer B, Bondy ML, Qu MQ, Smits A. Tumor-associated epilepsy and glioma; are there common genetic pathways? Acta Oncol. 2009;48:328–42.CrossRefGoogle Scholar
  6. 6.
    Blonski M, Taillandier L, Herbet G, Maldonado IL, Beauchesne P, Fabbro M, et al. Combination of neoadjuvant chemotherapy followed by surgical resection as a new strategy for WHO grade II gliomas: a study of cognitive status and quality of life. J Neurooncol. 2012;106:353–66.PubMedCrossRefGoogle Scholar
  7. 7.
    Brada M, Viviers L, Abson C, Hines F, Britton J, Ashley S, et al. Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol. 2003;14:1715–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Brogna C, Gil Robles S, Duffau H. Brain tumors and epilepsy. Expert Rev Neurother. 2008;8:941–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Casazza M, Gilioli I. Non-convulsive status epilepticus in brain tumors. Neurol Sci. 2011;32 Suppl 2:237–9.CrossRefGoogle Scholar
  10. 10.
    Cavaliere R, Farace E, Schiff D. Clinical implications of status epilepticus in patients with neoplasms. Arch Neurol. 2006;63:1746–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Chang EF, Potts MB, Keles GE, Lamborn KR, Chang SM, Barbaro NM, et al. Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg. 2008;108:227–35.PubMedCrossRefGoogle Scholar
  12. 12.
    Chen X, Dai J, Jiang T. Supratentorial WHO grade II glioma invasion: a morphologic study using sequential conventional MRI. Br J Neurosurg. 2010;24:196–201.PubMedCrossRefGoogle Scholar
  13. 13.
    Cibula JE, Gilmore RL. Secondary epileptogenesis in humans. J Clin Neurophysiol. 1997;14:111–27.PubMedCrossRefGoogle Scholar
  14. 14.
    Conti L, Palma E, Roseti C, Lauro C, Cipriani R, de Groot M, et al. Anomalous levels of Cl transporters cause a decrease of GABAergic inhibition in human peritumoral epileptic cortex. Epilepsia. 2011;52:1635–44.PubMedCrossRefGoogle Scholar
  15. 15.
    Danfors T, Ribom D, Berntsson SG, Smits A. Epileptic seizures and survival in early disease of grade 2 gliomas. Eur J Neurol. 2009;16:823–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Devinsky O. Patients with refractory seizures. N Engl J Med. 1999;340:1565–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Duffau H, Capelle L. Preferential brain locations of low-grade gliomas. Cancer. 2004;100:2622–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Engel Jr J, Van Ness PC, Rasmussen TB. Outcome with respect to epileptic seizures. In: Engel Jr J, editor. Surgical treatment of the epilepsies. 2nd ed. New York: Raven Press Ltd; 1993. p. 609–21.Google Scholar
  19. 19.
    Fassunke J, Majores M, Tresch A, Niehusmann P, Grote A, Schoch S, et al. Array analysis of epilepsy-associated gangliogliomas reveals expression patterns related to aberrant development of neuronal precursors. Brain. 2008;131:3034–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Fritschy JM. Epilepsy, E/I balance and GABA(A) receptor plasticity. Front Mol Neurosci. 2008;1:5.PubMedCrossRefGoogle Scholar
  21. 21.
    Glantz MJ, Cole BF, Forsyth PA, Recht LD, Wen PY, Chamberlain MC. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;54:1886–93.PubMedCrossRefGoogle Scholar
  22. 22.
    Hildebrand J, Lecaille C, Perennes J, Delattre JY. Epileptic seizures during follow-up of patients treated for primary brain tumors. Neurology. 2005;65:212–5.PubMedCrossRefGoogle Scholar
  23. 23.
    International League Against Epilepsy (ILAE). Commission on Epidemiology and Prognosis, International League Against Epilepsy Guidelines on epidemiologic studies on epilepsy. Epilepsia. 1993;34:592–6.CrossRefGoogle Scholar
  24. 24.
    Jaeckle KA, Ballman K, Furth A, Buckner JC. Correlation of enzyme-inducing anticonvulsant use with outcome of patients with glioblastoma. Neurology. 2009;13(73):1207–13.CrossRefGoogle Scholar
  25. 25.
    Jobst BC, Siegel AM, Thadani VM, Roberts DW, Rhodes HC, Williamson PD. Intractable seizures of frontal lobe origin: clinical characteristics, localizing signs, and results of surgery. Epilepsia. 2000;41:1139–52.PubMedCrossRefGoogle Scholar
  26. 26.
    Kaloshi G, Psimaras D, Mokhtari K, Dehais C, Houillier C, Marie Y, et al. Supratentorial low-grade gliomas in older patients. Neurology. 2009;73:2093–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Khan T, Akthar W, Wotton CJ, Hart Y, Turner MT, Goldacre MJ. Epilepsy and the subsequent risk of cerebral tumour: record linkage retrospective cohort study. J Neurol Neurosurg Psychiatry. 2011;82:1041–5.PubMedCrossRefGoogle Scholar
  28. 28.
    King MA, Newton MR, Jackson GD, Fitt GJ, Mitchell LA, Silvapulle MJ, et al. Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet. 1998;352:1007–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Klein M, Heimans JJ, Aaronson NK, van der Ploeg HM, Grit J, Muller M, et al. Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study. Lancet. 2002;360:1361–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Klein M, Engelberts NH, van der Ploeg HM, Kasteleijn-Nolst Trenité DG, Aaronson NK, Taphoorn MJ, et al. Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol. 2003;54:514–20.PubMedCrossRefGoogle Scholar
  31. 31.
    Kurzwelly D, Herrlinger U, Simon M. Seizures in patients with low-grade gliomas-incidence, pathogenesis, surgical management, and pharmacotherapy. Adv Tech Stand Neurosurg. 2010;35:81–111.PubMedCrossRefGoogle Scholar
  32. 32.
    Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342:314–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Lombardi D, Marsh R, de Tribolet N. Low grade glioma in intractable epilepsy: lesionectomy versus epilepsy surgery. Acta Neurochir Suppl. 1997;68:70–4.PubMedGoogle Scholar
  34. 34.
    Mandonnet E, Delattre JY, Tanguy ML, Swanson KR, Carpentier AF, Duffau H, et al. Continuous growth of mean tumor diameter in a subset of grade II gliomas. Ann Neurol. 2003;53:524–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Mandonnet E, Pallud J, Fontaine D, Taillandier L, Bauchet L, Peruzzi P, et al. Inter- and intrapatients comparison of WHO grade II glioma kinetics before and after surgical resection. Neurosurg Rev. 2010;33:91–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Manford M, Fish DR, Shorvon SD. An analysis of clinical seizure patterns and their localizing value in frontal and temporal lobe epilepsies. Brain. 1996;119:17–40.PubMedCrossRefGoogle Scholar
  37. 37.
    Mirsattari SM, Chong JJ, Hammond RR, Megyesi JF, Macdonald DR, Lee DH, Cairncross JG. Do epileptic seizures predict outcome in patients with oligodendroglioma? Epilepsy Res. 2011;94:39–44.PubMedCrossRefGoogle Scholar
  38. 38.
    Neligan A, Shorvon SD. Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review. Arch Neurol. 2010;67:931–40.PubMedCrossRefGoogle Scholar
  39. 39.
    Pace A, Vidiri A, Galiè E, Carosi M, Telera S, Cianciulli AM, et al. Temozolomide chemotherapy for progressive low-grade glioma: clinical benefits and radiological response. Ann Oncol. 2003;14:1722–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Pallud J, Mandonnett E. Quantitative approach of the natural course of diffuse low-grade gliomas. In: Hayat MA, editor. Tumors of the central nervous system, vol. 2. Dordrecht/New York: Springer AB; 2011. p. 163–72.CrossRefGoogle Scholar
  41. 41.
    Pallud J, Fontaine D, Duffau H, Mandonnet E, Sanai N, Taillandier L, et al. Natural history of incidental World Health Organization grade II gliomas. Ann Neurol. 2010;68:727–33.PubMedCrossRefGoogle Scholar
  42. 42.
    Pallud J, Mandonnet E, Deroulers C, Fontaine D, Badoual M, Capelle L, Club de Neuro-Oncologie de la Société Française de Neurochirurgie (SFNC); Association des Neuro-Oncologues d’Expression Française (ANOCEF), et al. Pregnancy increases the growth rates of World Health Organization grade II gliomas. Ann Neurol. 2010;67:398–404.PubMedGoogle Scholar
  43. 43.
    Pignatti F, van den Bent M, Curran D, Debruyne C, Sylvester R, Therasse P, European Organization for Research and Treatment of Cancer Brain Tumor Cooperative Group; European Organization for Research and Treatment of Cancer Radiotherapy Cooperative Group, et al. Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol. 2002;20:2076–84.PubMedCrossRefGoogle Scholar
  44. 44.
    Prayson RA. Brain tumors arising in the setting of chronic epilepsy. In: Hayat MA, editor. Tumors of the central nervous system, vol. 2. Dordrecht/New York: Springer AB; 2011. p. 407–16.CrossRefGoogle Scholar
  45. 45.
    Ricard D, Kaloshi G, Amiel-Benouaich A, Lejeune J, Marie Y, Mandonnet E, et al. Dynamic history of low-grade gliomas before and after temozolomide treatment. Ann Neurol. 2007;61:484–90.PubMedCrossRefGoogle Scholar
  46. 46.
    Rudà R, Trevisan E, Soffietti R. Epilepsy and brain tumors. Curr Opin Oncol. 2010;22:611–20.PubMedCrossRefGoogle Scholar
  47. 47.
    Schaller B, Rüegg SJ. Brain tumor and seizures: pathophysiology and its implications for treatment revisited. Epilepsia. 2003;44:1223–32.PubMedCrossRefGoogle Scholar
  48. 48.
    Shamji MF, Fric-Shamji EC, Benoit BG. Brain tumors and epilepsy: pathophysiology of peritumoral changes. Neurosurg Rev. 2009;32:275–84.PubMedCrossRefGoogle Scholar
  49. 49.
    Sherman JH, Moldovan K, Yeoh HK, Starke RM, Pouratian N, Shaffrey ME, et al. Impact of temozolomide chemotherapy on seizure frequency in patients with low-grade gliomas. J Neurosurg. 2011;114:1617–21.PubMedCrossRefGoogle Scholar
  50. 50.
    Shorvon S, Tomson T. Sudden unexpected death in epilepsy. Lancet. 2010;378:2028–38.CrossRefGoogle Scholar
  51. 51.
    Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26:1338–45.PubMedCrossRefGoogle Scholar
  52. 52.
    Smits A, Duffau H. Seizures and the natural history of World Health Organization grade II gliomas: a review. Neurosurgery. 2011;68:1326–33.PubMedGoogle Scholar
  53. 53.
    Soffietti R, Baumert BG, Bello L, von Deimling A, Duffau H, Frénay M, et al. European Federation of Neurological Societies. Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force. Eur J Neurol. 2010;17:1124–33.PubMedCrossRefGoogle Scholar
  54. 54.
    Swisher CB, Doreswamy M, Gingrich KJ, Vredenburgh JJ, Kolls BJ. Phenytoin, levetiracetam, and pregabalin in the acute management of refractory status epilepticus in patients with brain tumors. Neurocrit Care. 2011;16(1):109–13.CrossRefGoogle Scholar
  55. 55.
    Taillandier L, Duffau H. Epilepsy and insular Grade II gliomas: an interdisciplinary point of view from a retrospective monocentric series of 46 cases. Neurosurg Focus. 2009;27:E8.PubMedCrossRefGoogle Scholar
  56. 56.
    Taphoorn MJ, Klein M. Cognitive deficits in adult patients with brain tumours. Lancet Neurol. 2004;3:159–68.PubMedCrossRefGoogle Scholar
  57. 57.
    van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol. 2007;6:421–30.PubMedCrossRefGoogle Scholar
  58. 58.
    van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, EORTC Radiotherapy and Brain Tumor Groups and the UK Medical Research Council, et al. Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet. 2005;366:985–90.PubMedCrossRefGoogle Scholar
  59. 59.
    Weller M, Gorlia T, Cairncross JG, van den Bent MJ, Mason W, Belanger K, et al. Prolonged survival with valproic acid use in the EORTC/NCIC temozolomide trial for glioblastoma. Neurology. 2011;77:1156–64.PubMedCrossRefGoogle Scholar
  60. 60.
    Wen PY, Marks PW. Medical management of patients with brain tumors. Curr Opin Oncol. 2002;14:299–307.PubMedCrossRefGoogle Scholar
  61. 61.
    Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, et al. ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia. 2001;42:282–6.PubMedCrossRefGoogle Scholar
  62. 62.
    You G, Huang L, Yang P, Zhang W, Yan W, Wang Y, et al. Clinical and molecular genetic factors affecting postoperative seizure control of 183 Chinese adult patients with low-grade gliomas. Eur J Neurol. 2011;19(2):298–306.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of NeuroscienceNeurology Uppsala UniversityUppsalaSweden

Personalised recommendations