Full member of ERN EpiCARE, Epilepsy Center, Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Epilepsia. 2023 Jul;64(7):1853-1861. doi: 10.1111/epi.17658. Epub 2023 May 31.
Epilepsy is a common comorbidity of glioblastoma. Seizures may occur in various phases of the disease. We aimed to assess potential risk factors for seizures in accordance with the point in time at which they occurred.
We retrospectively analyzed medical files of adult patients with de novo glioblastoma treated at our institution between January 2006 and January 2020. We categorized seizures as preoperative seizures (POS), early postoperative seizures (EPS; before initiation of radio[chemo]therapy [RCT]), seizures during radiotherapy (SDR; during or <30 days after RCT), and posttherapeutic seizures (PTS; ≥30 days after completion of RCT). We addressed associations between patients' characteristics and their seizures.
In the final cohort (N = 520), 292 patients experienced seizures. POS, EPS, SDR, and/or PTS occurred in 29.6% (154/520), 6.0% (31/520), 13.8% (70/509), and 36.1% (152/421) of patients, respectively. POS occurred more frequently in patients with higher Karnofsky Performance Scale scores (odds ratio [OR] = 3.27, p = .001) and tumor location in the temporal lobe (OR = 1.51, p = .034). None of the parameters we analyzed was related to the occurrence of EPS. SDR were independently associated with tumor location (parietal lobe, OR = 1.86, p = .027) and POS, but not EPS, and were independent of RCT. PTS were independently associated with tumor progression (OR = 2.32, p < .001) and with occurrence of SDR (OR = 3.36, p < .001), and negatively correlated with temporal lobe location (OR = .58, p < .014). In patients with tumors exclusively located in the temporal lobe, complete tumor resection was associated with a decreased risk of postoperative seizures.
Seizures in glioblastoma patients have various, time-dependent risk factors. Temporal lobe localization was a risk factor for preoperative seizures; surgery may have had a protective effect in these patients. RCT did not have dose-dependent pro- or anticonvulsive effects. PTS were associated with tumor progression.
癫痫是胶质母细胞瘤的常见合并症。癫痫发作可能发生在疾病的各个阶段。我们旨在根据癫痫发作发生的时间点评估其潜在的危险因素。
我们回顾性分析了 2006 年 1 月至 2020 年 1 月期间在我们机构接受新诊断胶质母细胞瘤治疗的成年患者的病历。我们将癫痫发作分为术前癫痫发作（POS）、早期术后癫痫发作（EPS；在开始放化疗（RCT）之前）、放疗期间癫痫发作（SDR；在 RCT 期间或<30 天内）和治疗后癫痫发作（PTS；RCT 完成后≥30 天）。我们研究了患者特征与癫痫发作之间的关联。
在最终队列（N=520）中，292 名患者出现了癫痫发作。POS、EPS、SDR 和/或 PTS 分别发生在 29.6%（154/520）、6.0%（31/520）、13.8%（70/509）和 36.1%（152/421）的患者中。POS 在 Karnofsky 表现量表评分较高（优势比 [OR] =3.27，p=0.001）和肿瘤位于颞叶（OR=1.51，p=0.034）的患者中更常见。我们分析的参数均与 EPS 的发生无关。SDR 与肿瘤位置（顶叶，OR=1.86，p=0.027）和 POS 相关，但与 EPS 无关，且与 RCT 无关。PTS 与肿瘤进展（OR=2.32，p<0.001）和 SDR 的发生（OR=3.36，p<0.001）独立相关，与颞叶位置呈负相关（OR=0.58，p<0.014）。在肿瘤仅位于颞叶的患者中，完全肿瘤切除与术后癫痫发作风险降低相关。
胶质母细胞瘤患者的癫痫发作有多种、具有时间依赖性的危险因素。颞叶定位是术前癫痫发作的危险因素；手术可能对这些患者有保护作用。RCT 没有剂量依赖性的促或抗惊厥作用。PTS 与肿瘤进展相关。
