Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy.
Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy.
Seizure. 2017 Oct;51:157-162. doi: 10.1016/j.seizure.2017.08.009. Epub 2017 Aug 24.
Seizures are a common clinical symptom in high-grade gliomas (HGG). The aim of the study was to investigate the relationship between seizures and HGG relapse (HGG-R).
We retrospectively evaluated 145 patients who were surgically treated for HGG-R. By analyzing clinical characteristics in these patients (all operated and treated by the same protocol), we identified 37 patients with seizures during follow-up. This cohort was divided into four subgroups according to a) presence or absence of seizures at the time of diagnosis and b) temporal relationship between seizure occurrence and HGG-R during follow-up: subgroup A (25pts) had seizures at follow-up but not at onset, subgroup B (12pts) had seizures both at follow-up and onset, subgroup C (30pts) had seizures before MRI-documented HGG-R, and subgroup D (7pts) had seizures after MRI-documented HGG-R.
Although the datum was not statistically significant, survival was longer in patients with seizures during follow-up than in those without seizures (59.3% vs 51.4% alive at 2 years). In 30 patients (subgroup C) seizures heralded HGG-R. In a correlation analysis for this last subgroup, the time interval between seizure and the HGG-R was significantly associated with the number of chemotherapy cycles (r=0.470; p=0.009) and follow-up duration (r=0.566; p=0.001). A linear regression model demonstrated a reciprocal association between the above factors and that it may be possible to estimate the timing of HGG-R by combining these data.
Seizures may herald HGG-R before MRI detection of relapse, thus suggesting that seizures should always be considered a red flag during follow-up.
癫痫发作是高级别胶质瘤（HGG）的常见临床症状。本研究旨在探讨癫痫发作与 HGG 复发（HGG-R）之间的关系。
我们回顾性评估了 145 例接受 HGG-R 手术治疗的患者。通过分析这些患者的临床特征（均由同一方案进行手术和治疗），我们确定了 37 例在随访期间出现癫痫发作的患者。根据 a）诊断时是否存在癫痫发作和 b）癫痫发作与 HGG-R 在随访期间的时间关系，将该队列分为四个亚组：亚组 A（25 例）在随访期间出现癫痫发作，但在发病时没有；亚组 B（12 例）在随访期间和发病时均出现癫痫发作；亚组 C（30 例）在 MRI 证实 HGG-R 之前出现癫痫发作；亚组 D（7 例）在 MRI 证实 HGG-R 之后出现癫痫发作。
尽管数据没有统计学意义，但在随访期间出现癫痫发作的患者的生存率高于未出现癫痫发作的患者（2 年时存活的患者分别为 59.3%和 51.4%）。在 30 例（亚组 C）患者中，癫痫发作预示着 HGG-R。在对最后一组亚组进行相关性分析时，癫痫发作与 HGG-R 之间的时间间隔与化疗周期数（r=0.470；p=0.009）和随访时间（r=0.566；p=0.001）显著相关。线性回归模型表明，这些因素之间存在相互关联，通过结合这些数据，可能可以估计 HGG-R 的时间。
癫痫发作可能在 MRI 检测到复发之前预示着 HGG-R，因此，在随访期间，癫痫发作应始终被视为一个危险信号。
