Abstract
BackgroundEpilepsy is a major cause of morbidity and mortality in meningioma patients. The aims of this study were to determine which factors predispose meningioma patients to developing perioperative seizures and to understand the impact of antiepileptic drugs.MethodsPatients treated for a histologically-confirmed intracranial meningioma at the authors’ institution between 2010 and 2015 were retrospectively examined. Clinical and imaging data were assessed. Multivariate analysis was performed using binary logistic regression. The effect of antiepileptic treatment was assessed using survival analysis.ResultsTwo hundred and eighty-three patients met the selection criteria; seizures were present in 68 preoperatively (24%) and in 48 patients (17%) following surgery. Of the 68 with preoperative seizures, 19 continued to have them, whereas de-novo seizures arose postoperatively in 29 seizure-naïve patients. Risk factors of postoperative seizures were convexity location (OR 2.05 [95% CI 1.07–3.98], p = 0.030), fronto-parietal location (OR 4.42 [95% CI 1.49–13.16], p = 0.007) and preoperative seizures (OR 2.65 [95% CI 1.37–5.24], p = 0.005). The two locations, in addition to the presence of midline shift on preoperative imaging (OR 4.15 [95% CI 1.54–11.24], p = 0.005), were significantly correlated with postoperative seizures in seizure-naïve patients. Antiepileptic treatment in patients with those risk factors reduced the possibility of seizures at any time point within the 1st year postoperatively by approximately 40%, although this did not meet statistical significance.ConclusionProphylactic antiepileptic treatment might be warranted in seizure-naïve meningioma patients with ≥ 1 risk factor. High-quality randomised controlled trials are required to verify those factors and to define the role of antiepileptics in meningioma practice.
Highlights
Whilst focal neurological deficits and incidental discovery account for the majority of new diagnoses of intracranial meningioma [1, 2], approximately a third of patients present with focal epilepsy [3]
Epilepsy in meningioma patients is a major cause of morbidity and mortality [5, 6], but the rate at which new seizures develop in patients undergoing meningioma surgery varies, and the efficacy of Antiepileptic drugs (AEDs) in reducing post-operative seizure rates remains questionable [7, 8]
To investigate the risk factors associated with developing peri-operative epilepsy in meningioma patients, and to determine whether AEDs reduce the risk of postoperative seizures
Summary
Whilst focal neurological deficits and incidental discovery account for the majority of new diagnoses of intracranial meningioma [1, 2], approximately a third of patients present with focal epilepsy [3]. Antiepileptic drugs (AEDs) are indicated for the treatment of brain tumour-related seizures, there still remains no consensus on whether prophylactic AEDs should be prescribed in seizure-naïve patients to prevent the development of postoperative seizures [4]. Appropriate selection of patients at risk of developing epilepsy in the peri-operative period and who might benefit from AED treatment for meningioma resection is important. The aims of this study were to determine which factors predispose meningioma patients to developing perioperative seizures and to understand the impact of antiepileptic drugs. Antiepileptic treatment in patients with those risk factors reduced the possibility of seizures at any time point within the 1st year postoperatively by approximately 40%, this did not meet statistical significance. Conclusion Prophylactic antiepileptic treatment might be warranted in seizure-naïve meningioma patients with ≥ 1 risk factor. High-quality randomised controlled trials are required to verify those factors and to define the role of antiepileptics in meningioma practice
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