Department of Neuroscience and Neurology, Uppsala University, University Hospital, Uppsala, Sweden.
Neurosurgery. 2011 May;68(5):1326-33. doi: 10.1227/NEU.0b013e31820c3419.
The majority of adults with low-grade gliomas have seizures. Despite the frequency of seizures as initial symptoms and symptoms of later disease, seizures in relation to the natural course of low-grade gliomas have received little attention.
In this review, we provide an update of the literature on the prognostic impact of preoperative seizures and discuss the tumor- and treatment-related factors affecting seizure control at later stages of the disease.
Seizures occur most frequently at disease presentation and predict a more favorable outcome. Initial seizures are correlated with tumor location and possibly indirectly to the molecular profile of the tumor. About 50% of all patients with seizures at presentation continue to have seizures before surgery. Maximal tumor resection, including resection of epileptic foci, is a valuable strategy for improving seizure control. In addition, radiotherapy and chemotherapy, as single therapies or in combination with surgery, have shown beneficial effects in terms of seizure reduction. Recurrent seizures after macroscopically complete tumor resection may be a marker for accelerated tumor growth. Recurrent seizures after an initial transient stabilization after radiotherapy and/or chemotherapy may be a marker for anaplastic tumor transformation.
Preoperative seizures likely reflect, apart from tumor location, intrinsic tumor properties as well. Change in seizure control in individual patients is frequently associated with altered tumor behavior. Including seizures and seizure control as clinical parameters is recommended in future trials of low-grade gliomas to further establish the prognostic value of these symptoms and to identify the factors affecting seizure control.
大多数低级别胶质瘤患者会出现癫痫发作。尽管癫痫发作是初始症状和疾病后期症状，但与低级别胶质瘤自然病程相关的癫痫发作却很少受到关注。
在本综述中，我们对术前癫痫发作的预后影响进行了文献更新，并讨论了肿瘤和治疗相关因素对疾病后期癫痫发作控制的影响。
癫痫发作最常发生在疾病发作时，且预测预后较好。初始癫痫发作与肿瘤位置相关，可能与肿瘤的分子特征间接相关。约有 50%的首发癫痫患者在手术前仍有癫痫发作。最大限度地切除肿瘤，包括切除癫痫灶，是改善癫痫发作控制的有效策略。此外，放疗和化疗作为单一疗法或联合手术，在减少癫痫发作方面显示出有益效果。在宏观上完全切除肿瘤后复发的癫痫发作可能是肿瘤生长加速的标志。在放疗和/或化疗初始短暂稳定后复发的癫痫发作可能是肿瘤发生间变的标志。
除了肿瘤位置外，术前癫痫发作可能还反映了肿瘤的内在特性。个别患者的癫痫发作控制情况的变化常与肿瘤行为的改变相关。在未来的低级别胶质瘤试验中，建议将癫痫发作和癫痫发作控制作为临床参数，以进一步确定这些症状的预后价值，并确定影响癫痫发作控制的因素。
