Abstract
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.
Highlights
Epilepsy is among the most common clinical presentations of brain tumors, and seizures often present as the first clinical symptom
We propose an algorithm for the diagnosis and perioperative management for Glioma related epilepsy (GRE), hoping to provide a better standard for improving seizure control in patients with gliomas
Diagnosis of GRE should be based on the coexistence and causal relationship of glioma and epilepsy
Summary
Epilepsy is among the most common clinical presentations of brain tumors, and seizures often present as the first clinical symptom. The incidences of epilepsy in patients with gliomas range from 40 to 90%, depending on the tumor types [1,2,3,4,5]. Because tumor itself contributes significantly to seizure occurrence, most GRE patients could become seizure-free in the early stage after tumor resection. Gross total resection remains an independent positive predictor for postoperative seizure control [2, 12, 13]. We propose an algorithm for the diagnosis and perioperative management for GRE, hoping to provide a better standard for improving seizure control in patients with gliomas
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