Correlation epilepsy of low-level diffuse glioma

Backgroundepilepsy is a common symptom of glioma, the pathogenesis and incidence of which are related to tumor type, level and site and tumor circumstantial cortex changesLow-grade gliomas cause more epilepsy than high-level gliomasLow-level diffuse glioma (DLGG) seizures are most common in adultsEpilepsy and anti-epileptic drug use can lead to cognitive impairment in patients, affecting the long-term quality of life and tumor treatment effectsUncontrollable DLGG seizures require treatment for tumors, including surgery, radiotherapy and chemotherapy to improve anti-epileptic effectsJohan Pallud, of Neurosurgery at Sainte-Anne Hospital in France, reviewed the literature to summarize the incidence, pathogenesis, therapeutic effect and prognosis factors of epilepsy associated with DLGG in adultsThis article was published online in Neurosurg Clin N Am in November 2018methodthe International Society against Epilepsy (ILAE) defines tumor-related epilepsy as a persistent tumor lesions in the brain, such as DLGG, which cause seizures of more than 1 seizureMore than 80% of DLGG patients can develop epilepsy, more than 90% of patients thus attract attention, medical examination and diagnosisThe risk of seizures decreases with the age of the patient; The incidence of epilepsy in cortical DLGGs such as frontal, temporal, island and top lobes was higher than that of deep tumorsThe effects of histopathological types and biomolecular markers on the risk of epilepsy are not recognizedthe International Anti-Epilepsy Alliance (ILAE) defines uncontrolled epilepsy (uncontrolled seizures) or refractory epilepsy as epilepsy that is still difficult to control after a reasonable selection and correct use of at least 2 single anti-epileptic drugs with good tolerance or combined usePrior to DLGG treatment, the incidence of refractory epilepsy was about 15%-50%, which was associated with the length of time between the first seizure of epilepsy and the treatment of the tumorThere is growing evidence that any type of glioma grows in the stimulating cortex with epilepsy, which in turn promotes the growth of gliomasFree tumor cells in Patients with DLGG soak edithe the surrounding cortex of the tumor and form multiple eclampsia lesions in the cortex during the tumor Through preoperative electrophysiology, including the study of brain magnetography, surface electroencephalogram and stereoscopic electroencephalography, as well as electrooperative physiology, including direct electroencephalography and epidermal electroencephalography, it has been made clear that epilepsy activity mainly occurs in the surrounding cortex of tumors surgical removal of DLGG can control 36%-100% of DLGG epilepsy, and the degree of tumor removal is an important predictor of postoperative epilepsy control (Figure 1) However, eclampsia may be located in tumor-free brain tissue during the tumor, and even if imaging shows that the tumor was completely excisioned, there are still patients with epilepsy that is not satisfactorily controlled after surgery The scope of removal of DLGG must meet both the requirements of tumor treatment and epilepsy treatment Figure 1 The effect of surgical removal on DLGG-related seizures 1 case of 33-year-old female right hand patients, some motor seizures and secondary systemic seizures, taking an anti-epileptic drug (AED) can control epilepsy Mr MRI shows the right frontal lobe lump (Figure A) In general anaesthetic down the total excision (Figure B), diagnosed as WHO level II IDH1 mutant type of small protrusion glioma 5 months after the operation, the seizure relapsed, added the second AED, the seizure is still not under control MRI indicates that residual tumors continue to grow (Figure C) In the state of sobriety, the second operation of the line, using the direct electrical stimulation of the midoperative cortex and subcortical electrical stimulation line, was removed beyond the boundary of the abnormal tissue shown in MRI After the second operation, the seizures were controlled The first AED was discontinued 6 months after surgery and the second AED was discontinued 30 months after surgery After 6 years of follow-up, the patient had no seizures and no recurrence of glioma (Figure D) Cognitive function assessment improved compared to preoperative results the antidote temolamine chemotherapy to alleviate 50%-60% of DLGG-related epilepsy and 20-40% of patients stopped having seizures The control of epilepsy in combination with chemotherapy is better than the use of anti-epileptic drugs alone (Figure 2) The benefits of pyroquine to relieve seizures predate the reduction of tumors seen in imaging PcV chemotherapy has also been reported to be effective for DLGG-related epilepsy Figure 2 Effects of temolymine on DLGG-related seizures 1 case of 37-year-old female right hand patients, 5 months pregnant with a systemic strong straight seizure, MRI shows the left temporal lobe lump (Figure A) With an AED, epilepsy remains uncontrolled 3 months after the successful delivery, a stereotactic biopsy (Figure B) was diagnosed with WHO LEVEL II IDH mutant astrocyma After 7 months of delivery, chemotherapy (12 cycles, 1 year) was received, and after 3 cycles of administration, epilepsy was controlled and MRI gliomas did not progress (Figure C) AED was discontinued seven months after the end of chemotherapy After 3.5 years of postoperative follow-up, the patient had no seizures and an MRI scan did not observe the progression of glioma (Figure D) There are few studies radiation therapy to control DLGG-related epilepsy Radiotherapy has been reported to relieve 75% of patients with uncontrolled DLGG epilepsy (Figure 3) Epilepsy may improve early in radiotherapy, even before the tumor smaller than the imaging shown There are also reports that after early radiotherapy, patients with refractory epilepsy accounted for 25%, while in patients with late radiotherapy, refractory epilepsy accounted for 41%, the effect of early radiotherapy is better No differences in epilepsy control were found in large doses (54.9Gy) and small doses (45Gy) for radiotherapy Figure 3 Effects of radiotherapy on DLGG-related seizures 1 case of 26-year-old female right hand patients, have a simple part of the motor seizures, after taking 2 types of AED still can not control epilepsy MRI shows the left forehead lump (Figure A) After the function positioning in the operative, the tumor partial excision (Figure B) was carried out using the cortical and subcortical direct electrical stimulation in the waking state, and the TUMOR level II IDH mutant hybrid glioma was diagnosed 5 months after the operation, the epilepsy recurs and a third Form AED is taken MRI shows residual tumor growth (Figure C) One year after the operation, three AEdEs were taken and the epilepsy was still relapsed and uncontrolled The form-fit radiation therapy (50.4Gy), after 9 months of seizures are controlled, after 1 year of radiotherapy, the second AED, 2 years after radiotherapy, the suspension of the third AED After 5 years of follow-up, the patient had no seizures and THE MRI scan did not observe the progression of glioma (Figure D) conclusions clinical practice shows that treated DLGG patients need imaging examination if they have no seizures and later new seizures, or if the frequency of seizures increases, indicating tumor progression Epilepsy often occurs earlier than imaging of visible tumor progression The electrophysiological abnormalities associated with gliomas are found in almost all glioma progression periods In Patients with DLGG, having epilepsy had a better prognosis than those without seizures Studies have found that the total survival rates of DLGG patients with and without epilepsy were 90 months and 50 months, respectively At the same time, DLGGs with epilepsy are less likely to develop tumors into malignant conversions, so-called malignant progression-free survival In short, the presence of seizures is conducive to the survival of Patients with DLGG prognosis factors.