Corresponding Author: Roberta Rudà, MD, Department of Neuro-Oncology, Via Cherasco 15, 10126 Torino, Italy.
Neuro Oncol. 2013 Dec;15(12):1739-49. doi: 10.1093/neuonc/not109. Epub 2013 Jul 28.
Little information is available regarding the effect of conventional radiotherapy on glioma-related seizures.
In this retrospective study, we analyzed the seizure response and outcome following conventional radiotherapy in a cohort of 43 patients with glioma (33 grade II, 10 grade III) and medically intractable epilepsy.
At 3 months after radiotherapy, seizure reduction was significant (≥ 50% reduction of frequency compared with baseline) in 31/43 patients (72%) of the whole series and in 25/33 patients (76%) with grade II gliomas, whereas at 12 months seizure reduction was significant in 26/34 (76%) and in 19/25 (76%) patients, respectively. Seizure reduction was observed more often among patients displaying an objective tumor response on MRI, but patients with no change on MRI also had a significant seizure reduction. Seizure freedom (Engel class I) was achieved at 12 months in 32% of all patients and in 38% of patients with grade II tumors. Timing of radiotherapy and duration of seizures prior to radiotherapy were significantly associated with seizure reduction.
This study showed that a high proportion of patients with medically intractable epilepsy from diffuse gliomas derive a significant and durable benefit from radiotherapy in terms of epilepsy control and that this positive effect is not strictly associated with tumor shrinkage as shown on MRI. Radiotherapy at tumor progression seems as effective as early radiotherapy after surgery. Prospective studies must confirm and better characterize the response to radiotherapy.
关于常规放疗对胶质瘤相关癫痫发作的影响，相关信息有限。
在这项回顾性研究中，我们分析了 43 例胶质瘤（33 级 2 例，10 级 3 例）和药物难治性癫痫患者接受常规放疗后的癫痫发作反应和结果。
放疗后 3 个月，整个系列 43 例患者中有 31 例（72%）和 2 级胶质瘤患者中有 25 例（76%）的癫痫发作明显减少（与基线相比，频率减少≥50%），而放疗后 12 个月时，34 例中有 26 例（76%）和 25 例中有 19 例（76%）的癫痫发作明显减少。在 MRI 上显示肿瘤客观反应的患者中，癫痫发作减少的情况更为常见，但 MRI 无变化的患者也有明显的癫痫发作减少。所有患者中有 32%在 12 个月时达到癫痫无发作（Engel 分级 I），2 级肿瘤患者中有 38%达到癫痫无发作。放疗时间和放疗前癫痫发作的持续时间与癫痫发作减少显著相关。
这项研究表明，大多数药物难治性癫痫的弥漫性胶质瘤患者在癫痫控制方面从放疗中获得了显著且持久的益处，并且这种积极影响与 MRI 上显示的肿瘤缩小并不严格相关。肿瘤进展时的放疗与术后早期放疗一样有效。前瞻性研究必须证实并更好地描述对放疗的反应。
