Ollila Leena, Roivainen Reina
Department of Neurology, Neurocenter, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Finland.
Epilepsy Behav Rep. 2023 Jan 13;21:100586. doi: 10.1016/j.ebr.2023.100586. eCollection 2023.
An epileptic seizure is a common presenting symptom of glioma, or epilepsy may develop later during the disease. Epileptic seizures affect the quality of life in patients with glioma. Good seizure control during 6-12 months follow-up has been associated with gross total resection, radiation therapy and chemotherapy of gliomas. Little is known about seizure control during long-term follow-up and about factors which may affect the prognosis of epilepsy in glioma patients.
We identified retrospectively all adult patients with diffuse glioma (grade 2-4) associated epilepsy (n = 123) living in Helsinki, who received treatment at Helsinki University Hospital neuro-oncology center during 2013-2015. We excluded patients with histopathological diagnosis prior to 2005. Data was collected from medical records for five years after diagnosis of glioma, or until death.
In this patient cohort 49 (39.8 %) had grade 2 glioma, 19 (15.4 %) had grade 3 glioma and 55 (44.7 %) had grade 4 glioma. 29 (23.6 %) of tumors were astrocytomas, 24 (19.5 %) were oligoastrocytomas, 15 (12.2 %) were oligodendrogliomas and 55 (44.7 %) were glioblastomas. A seizure was the presenting symptom in 87 (70.7 %) of the patients. The majority, 68 (57.6 %) patients were seizure-free for at least 12 months at some point during follow-up and 47 (39.8 %) patients were seizure-free during the last year of follow-up. Survival for five years from glioma diagnosis (p < 0.001), lower grade of tumor (p < 0.001), IDH mutation (p < 0.001), epilepsy as first symptom (p < 0.001), younger age (p < 0.001) and lack of progression (p = 0.021) correlated with seizure freedom at the end of follow-up. When the results were analyzed separately in survivors and deceased patients, only progression correlated negatively with seizure freedom at the end of follow-up in surviving patients (p = 0.008). In 5-year survivors, longer seizure-free periods were achieved by patients without progression of glioma (p = 0.040) vs patients with progression, or without focal aware (p 0.003) or focal impaired awareness seizures (p = 0.002) vs patients with only focal to bilateral tonic-clonic seizures. In deceased patients, progression (p < 0.001) and lower grade of glioma (p = 0.003) correlated positively and focal aware seizures negatively (p = 0.021) with a longer seizure-free period. In all patients, freedom of seizures at the end of follow-up was less likely for patients who had focal aware (p = 0.015) than for patients without focal aware seizures.
There are differences in seizure-free times in patients with grade 2-4 glioma and epilepsy. The results suggest that the prognosis of glioma may be the most important factor influencing the prognosis of epilepsy.
癫痫发作是胶质瘤常见的首发症状，或者在疾病后期可能会出现癫痫。癫痫发作会影响胶质瘤患者的生活质量。在6 - 12个月的随访期间，良好的癫痫控制与胶质瘤的全切除、放疗和化疗相关。关于长期随访期间的癫痫控制以及可能影响胶质瘤患者癫痫预后的因素，我们了解得很少。
我们回顾性地确定了所有居住在赫尔辛基、于2013 - 2015年在赫尔辛基大学医院神经肿瘤中心接受治疗的成年弥漫性胶质瘤（2 - 4级）合并癫痫患者（n = 123）。我们排除了2005年之前有组织病理学诊断的患者。从胶质瘤诊断后的五年医疗记录中收集数据，直至死亡。
在这个患者队列中，49例（39.8%）为2级胶质瘤，19例（15.4%）为3级胶质瘤，55例（44.7%）为4级胶质瘤。29例（23.6%）肿瘤为星形细胞瘤，24例（19.5%）为少突星形细胞瘤，15例（12.2%）为少突胶质细胞瘤，55例（44.7%）为胶质母细胞瘤。87例（70.7%）患者以癫痫发作为首发症状。大多数患者，68例（57.6%）在随访的某个时间点至少12个月无癫痫发作，47例（39.8%）患者在随访的最后一年无癫痫发作。胶质瘤诊断后五年生存率（p < 0.001）、较低的肿瘤分级（p < 0.001）、异柠檬酸脱氢酶（IDH）突变（p < 0.001）、癫痫作为首发症状（p < 0.001）、较年轻的年龄（p < 0.001）以及无疾病进展（p = 0.021）与随访结束时无癫痫发作相关。当分别对存活患者和死亡患者的结果进行分析时，仅疾病进展与存活患者随访结束时的无癫痫发作呈负相关（p = 0.008）。在5年存活者中，与有疾病进展的患者相比，无胶质瘤进展的患者癫痫无发作期更长（p = 0.040）；与仅有局灶性发作继发双侧强直 - 阵挛性发作的患者相比，无局灶性发作意识（p = 0.003）或局灶性发作意识障碍（p = 0.002）的患者癫痫无发作期更长。在死亡患者中，疾病进展（p < 0.001）和较低级别的胶质瘤（p = 0.003）与较长的癫痫无发作期呈正相关，局灶性发作意识与较长的癫痫无发作期呈负相关（p = 0.021）。在所有患者中，有局灶性发作意识的患者随访结束时无癫痫发作的可能性低于无局灶性发作意识的患者（p = 0.015）。
2 - 4级胶质瘤合并癫痫患者的癫痫无发作时间存在差异。结果表明，胶质瘤的预后可能是影响癫痫预后的最重要因素。
