scholarly journals Clinical Diagnosis and Perioperative Management of Glioma-Related Epilepsy

2021 ◽  
Vol 10 ◽  
Author(s):  
Gan You ◽  
Zhiyi Sha ◽  
Tao Jiang
Keyword(s):  
Perioperative Management ◽  
Seizure Control ◽  
Clinical Presentation ◽  
Epileptic Seizures ◽  
High Grade Glioma ◽  
Low Grade ◽  
Tumor Treatment ◽  
Multiple Factors ◽  
Close Relationship

Gliomas account for more than half of all adult primary brain tumors. Epilepsy is the most common initial clinical presentation in gliomas. Glioma related epilepsy (GRE) is defined as symptomatic epileptic seizures secondary to gliomas, occurring in nearly 50% in high-grade glioma (HGG) patients and up to 90% in patients with low-grade glioma (LGG). Uncontrolled seizures, which have major impact on patients’ quality of life, are caused by multiple factors. Although the anti-seizure medications (ASMs), chemotherapy and radiation therapy are also beneficial for seizure treatment, the overall seizure control for GRE continue to be unsatisfactory. Due to the close relationship between GRE and glioma, surgical resection is often the treatment of choice not only for the tumor treatment, but also for the seizure control. Despite aggressive surgical treatment, there are about 30% of patients continue to have poor seizure control postoperatively. Furthermore, the diagnostic criteria for GRE is not well established. In this review, we propose an algorithm for the diagnosis and perioperative management for GRE.

scholarly journals Epilepsy in Down Syndrome: A Highly Prevalent Comorbidity

2021 ◽  
Vol 10 (13) ◽  
pp. 2776
Author(s):  
Miren Altuna ◽  
Sandra Giménez ◽  
Juan Fortea
Keyword(s):  
Down Syndrome ◽  
Functional Outcomes ◽  
Clinical Presentation ◽  
Late Onset ◽  
Current Knowledge ◽  
Epileptic Seizures ◽  
Myoclonic Epilepsy ◽  
Increased Risk ◽  
Number Of Individuals

Individuals with Down syndrome (DS) have an increased risk for epilepsy during the whole lifespan, but especially after age 40 years. The increase in the number of individuals with DS living into late middle age due to improved health care is resulting in an increase in epilepsy prevalence in this population. However, these epileptic seizures are probably underdiagnosed and inadequately treated. This late onset epilepsy is linked to the development of symptomatic Alzheimer’s disease (AD), which is the main comorbidity in adults with DS with a cumulative incidence of more than 90% of adults by the seventh decade. More than 50% of patients with DS and AD dementia will most likely develop epilepsy, which in this context has a specific clinical presentation in the form of generalized myoclonic epilepsy. This epilepsy, named late onset myoclonic epilepsy (LOMEDS) affects the quality of life, might be associated with worse cognitive and functional outcomes in patients with AD dementia and has an impact on mortality. This review aims to summarize the current knowledge about the clinical and electrophysiological characteristics, diagnosis and treatment of epileptic seizures in the DS population, with a special emphasis on LOMEDS. Raised awareness and a better understanding of epilepsy in DS from families, caregivers and clinicians could enable earlier diagnoses and better treatments for individuals with DS.

scholarly journals The effects of epileptic seizures upon quality of life

2009 ◽  
Vol 15 (3) ◽  
pp. 110-113 ◽  
Author(s):  
Priscila Camile Barioni Salgado ◽  
Fernando Cendes
Keyword(s):  
Quality Of Life ◽  
Seizure Frequency ◽  
Seizure Control ◽  
Epileptic Seizures ◽  
Anxiety And Depression ◽  
Co Morbidity ◽  
Item Quality ◽  
Patients With Epilepsy ◽  
And Control

OBJECTIVE: understand the psychological considerations of the relationship between the effect of seizures upon the patients' perception of seizure control, depression, anxiety and quality of life (QoL). METHODS: 151 adult patients with epilepsy diagnosed for over two years were interviewed and responded the 31-Item Quality of Life in Epilepsy (QOLIE-31), the Trait Form of the State/Trait Anxiety Inventory (STAI II) and the Beck Depression Inventory (BDI). RESULTS: 45 patients were depressed (29.8%) and 29 (19.2%) had anxiety. Depression scores ranged from 0 to 49 (M=7.4; SD=8.9) and anxiety scores ranged from 19 to 69 (M=41.5, SD=11.9). Total QoL score was correlated to seizure control (p<0.001), perception of epilepsy control (p<0.001), anxiety (p<0.001), and depression (p=0.003). The perception of epilepsy control was correlated to seizure control (p<0.001), seizure frequency (p=0.001), anxiety (p<0.001) and depression (p<0.001). Seizure control was associated to anxiety (p=0.033) and depression (p<0.001). There was co-morbidity between anxiety and depression (p<0.001). CONCLUSION: This study highlights the importance of the seizure frequency and control to the evaluation of perception of epilepsy control and shows that anxiety and depression in epilepsy are predicted by seizure-related (seizure frequency and control) and psychosocial aspects (perception of control and QoL) together.

Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life

2013 ◽  
Vol 119 (2) ◽  
pp. 318-323 ◽  
Author(s):  
Philippe Schucht ◽  
Fadi Ghareeb ◽  
Hugues Duffau
Keyword(s):  
Quality Of Life ◽  
Return To Work ◽  
Seizure Control ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Neurological Deficits ◽  
Main Concern ◽  
Low Grade ◽  
Who Grade

Object A main concern with regard to surgery for low-grade glioma (LGG, WHO Grade II) is maintenance of the patient's functional integrity. This concern is particularly relevant for gliomas in the central region, where damage can have grave repercussions. The authors evaluated postsurgical outcomes with regard to neurological deficits, seizures, and quality of life. Methods Outcomes were compared for 33 patients with central LGG (central cohort) and a control cohort of 31 patients with frontal LGG (frontal cohort), all of whom had had medically intractable seizures before undergoing surgery with mapping while awake. All surgeries were performed in the period from February 2007 through April 2010 at the same institution. Results For the central cohort, the median extent of resection was 92% (range 80%–97%), and for the frontal cohort, the median extent of resection was 93% (range 83%–98%; p = 1.0). Although the rate of mild neurological deficits was similar for both groups, seizure freedom (Engel Class I) was achieved for only 4 (12.1%) of 33 patients in the central cohort compared with 26 (83.9%) of 31 patients in the frontal cohort (p < 0.0001). The rate of return to work was lower for patients in the central cohort (4 [12.1%] of 33) than for the patients in the frontal cohort (28 [90.3%] of 31; p < 0.0001). Conclusions Resection of central LGG is feasible and safe when appropriate intraoperative mapping is used. However, seizure control for these patients remains poor, a finding that contrasts markedly with seizure control for patients in the frontal cohort and with that reported in the literature. For patients with central LGG, poor seizure control ultimately determines quality of life because most will not be able to return to work.

Seizure Surgery

2018 ◽  
Author(s):  
Caroll N. Vazquez-Colon ◽  
Srijaya K. Reddy
Keyword(s):  
Pediatric Patients ◽  
Perioperative Management ◽  
Seizure Control ◽  
Refractory Epilepsy ◽  
Intraoperative Neuromonitoring ◽  
Anesthetic Agents ◽  
Anesthetic Drugs ◽  
Seizure Surgery ◽  
Antiepileptic Medications

Epilepsy is a disorder of the nervous system that affects over 2 million people worldwide, with the highest incidence in children. Surgical management of a child with refractory epilepsy may result in improved seizure control and better quality of life. The perioperative management of the pediatric patient for seizure surgery presents a considerable challenge to the anesthesiologist. Primary concerns include the interactions of antiepileptic medications with anesthetic drugs, the effects of anesthetic agents and medications on intraoperative neuromonitoring, and management of seizures while under anesthesia. This chapter will focus on anesthetic concerns and management for pediatric patients presenting for seizure surgery.

scholarly journals Systematic Review - Time To Malignant Transformation In Low Grade Gliomas: Predicting A Catastrophic Event With Clinical, Neuroimaging And Molecular Markers

2021 ◽  
Author(s):  
Zabina Satar ◽  
Gary Hotton ◽  
George Samandouras
Keyword(s):  
Malignant Transformation ◽  
Epileptic Seizures ◽  
Therapeutic Interventions ◽  
Low Grade ◽  
Invasive Treatment ◽  
Who Grade ◽  
Grade Ii ◽  
Cortical Involvement ◽  
Impaired Quality

Abstract Background Despite an initially indolent course, all WHO grade II, LGGs inevitably transform to malignant, WHO grades III and IV, without current curative options. Malignant transformation (MT) remains unpredictable with limited prognostic markers to steer timing of interventions. The aim of this study was to review and assign predictive value to specific clinical, molecular and radiological markers impacting MT, thereby justifying timely therapeutic interventions. Methods Searches of MEDLINE, Embase and Cochrane databases were conducted from inception to April 28, 2021 and outputs were analysed in accordance with PRISMA protocol. Results From an initial 5,032 articles, 31 articles were included, totalling 5,193 patients. Forty-three prognostic factors were registered to significantly impact MT. These were categorised as 7 clinical; 14 neuroimaging; 8 biological/molecular; 3 volumetric; 5 topological; 3 histological; and 3 treatment-related. Following analysis, 10 factors were highlighted: the pre-operative prognosticators were 1. presentation with epileptic seizures; 2. VDE &gt;8mm/year; 3. VDE &gt;4mm/year; 4. rCBV &gt;1.75; 5. PTV ≥5 cm (65ml); 6. PTV ≥100 ml; and 7. cortical involvement. The post-operative prognosticators were 1.IDH-wt; 2. TP53 mutation; and 3. temozolomide monotherapy. Conclusions The management of LGGs remains controversial, as conservative and invasive treatment may be associated with MT and impaired quality of life, respectively. Our review indicates that MT can be predicted by specific metrics in VDE, PTV and rCBV, alongside cortical involvement. Additionally, patients with IDH-wt tumours TP53 mutations, or receiving TMZ monotherapy are more likely to undergo MT. Our data may form the basis of a predictive scoring system.

scholarly journals Symptomatic Epileptic Seizures in Patients with Brain Gliomas

2021 ◽  
Vol 10 (3) ◽  
pp. 549-557
Author(s):  
D. I. Abzalova ◽  
A. V. Prirodov ◽  
M. V. Sinkin
Keyword(s):  
Antiepileptic Drugs ◽  
Tumor Resection ◽  
Epileptic Seizures ◽  
Low Grade ◽  
Drug Resistant ◽  
Newly Diagnosed ◽  
New Antiepileptic Drugs ◽  
Cerebral Gliomas ◽  
Brain Gliomas

Introduction. Epileptic seizures are an important problem that significantly worsens the quality of patients’ life with both newly diagnosed and recurrent brain gliomas.Review. The analysis of domestic and foreign literature showed that low-grade gliomas, this symptom occurs on average in 76%, with high-grade gliomas – in 21% of patients. Despite the maximum allowable tumor resection, it is likely that epileptic seizures persist in 18-64% of patients, and in 5% of patients they first appear in the postoperative period. From 15 to 50% of epileptic seizures in cerebral gliomas are drug-resistant. In patients undergoing chemotherapy, it is better to use new antiepileptic drugs because their cross-effects are minimal.Conclusion. There is no generally accepted algorithm for prescribing and discontinuing antiepileptic drugs in patients with symptomatic epileptic seizures with cerebral gliomas. Further research is needed to determine the optimal combination and dosage regimen of antiepileptic drugs, especially during chemotherapy.

scholarly journals Seizure control as a new metric in assessing efficacy of tumor treatment in low-grade glioma trials

2016 ◽  
Vol 19 (1) ◽  
pp. 12-21 ◽  
Author(s):  
Edward K. Avila ◽  
Marc Chamberlain ◽  
David Schiff ◽  
Jaap C. Reijneveld ◽  
Terri S. Armstrong ◽  
...  
Keyword(s):  
Seizure Control ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Tumor Treatment

scholarly journals Epilepsy in the end of life phase of brain tumor patients: a systematic review

2014 ◽  
Vol 1 (3) ◽  
pp. 134-140 ◽  
Author(s):  
Johan A.F. Koekkoek ◽  
Linda Dirven ◽  
Jaap C. Reijneveld ◽  
Tjeerd J. Postma ◽  
Robin Grant ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Tumor ◽  
End Of Life ◽  
Current Knowledge ◽  
Epileptic Seizures ◽  
High Grade Glioma ◽  
Malignant Brain Tumor ◽  
Tumor Patients ◽  
Swallowing Difficulties

Abstract Epileptic seizures are common in patients with primary or secondary malignant brain tumor. However, current knowledge on the occurrence of seizures during the end of life (EOL) phase of brain tumor patients is limited. Because symptom management with preservation of quality of life is of major importance for patients with a malignant brain tumor, particularly in the EOL, it is necessary to gain a deeper understanding of seizures and their management during this phase. We performed a systematic review of literature related to epilepsy in the EOL phase of brain tumor patients, based on the electronic resources PubMed, Embase, and Cinahl. The search yielded 442 unique records, of which 11 articles were eligible for further analysis after applying predefined inclusion criteria. Seizures occur relatively frequently in the EOL phase, particularly in patients with high-grade glioma. However, seizure management is often hampered by swallowing difficulties and impaired consciousness. Treatment decisions are largely dependent on expert opinion because a standardized approach for treating seizures in the terminal stage of brain tumor patients is still lacking.

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