Westermark Ann, Fahlström Markus, Mirza Sadia, Zetterling Maria, Kumlien Eva, Latini Francesco
Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Molecular Imaging and Medical Physics, Uppsala University, Uppsala, Sweden.
Brain Behav. 2025 Apr;15(4):e70477. doi: 10.1002/brb3.70477.
Seizure incidence in diffuse glioma ranges between 60% and 90%. This study aimed to investigate the association between seizures and diffuse glioma in subcortical and cortical brain regions, including white matter tracts.
Adult patients with diffuse glioma at Uppsala University Hospital from 2005 to 2021 were analysed retrospectively. The relationship between tumour location in specific brain voxels and preoperative seizures was examined concerning white matter tract involvement. Tumour volumes were segmented based on T2-weighted or FLAIR MRI after spatial normalisation to standard space (MNI) and combined to create a location-specific frequency map.
Of the 93 patients meeting the inclusion criteria, 70 (75%) experienced seizures. A significant decreased risk was found in tumours present within the left fronto-mesial and dorsal voxel (A3C1S1). Increased seizure risk was found in tumours located in the left supramarginal and posterior insular voxel (A4C2S3). The voxels differed in terms of type and extent of white matter networks. Additionally, there was a difference in seizure risk and voxel associations between oligodendrogliomas and astrocytoma, with specific voxels associated with seizures identified in both groups.
The study provides new insights into the epileptogenic potential of diffuse gliomas in relation to their spatial distribution, highlighting the need to analyse both cortical and subcortical localisation of tumours. The observed differences in seizure risks across brain regions underscore the need for personalised post-surgery treatment strategies and further research to understand the pathophysiology of brain tumour-related epilepsy, BTRE.
弥漫性胶质瘤的癫痫发作发生率在60%至90%之间。本研究旨在调查癫痫发作与大脑皮质下和皮质区域（包括白质束）弥漫性胶质瘤之间的关联。
对2005年至2021年在乌普萨拉大学医院就诊的成年弥漫性胶质瘤患者进行回顾性分析。研究了特定脑体素中的肿瘤位置与术前癫痫发作之间的关系，涉及白质束受累情况。在将肿瘤体积基于T2加权或液体衰减反转恢复（FLAIR）磁共振成像（MRI）进行空间归一化至标准空间（蒙特利尔神经病学研究所，MNI）后进行分割，并合并以创建特定位置的频率图。
在符合纳入标准的93例患者中，70例（75%）有癫痫发作。发现位于左侧额内侧和背侧体素（A3C1S1）的肿瘤风险显著降低。位于左侧缘上回和岛叶后部体素（A4C2S3）的肿瘤癫痫发作风险增加。这些体素在白质网络的类型和范围方面存在差异。此外，少突胶质细胞瘤和星形细胞瘤在癫痫发作风险和体素关联方面存在差异，两组中均发现了与癫痫发作相关的特定体素。
本研究为弥漫性胶质瘤的致痫潜力与其空间分布的关系提供了新的见解，强调了分析肿瘤皮质和皮质下定位的必要性。在不同脑区观察到的癫痫发作风险差异凸显了术后个性化治疗策略的必要性，以及进一步研究以了解脑肿瘤相关性癫痫（BTRE）病理生理学的必要性。
