Status epilepticus in patients with glioblastoma: Clinical characteristics, risk factors, and epileptological outcome.

Abstract

Epilepsy is a common comorbidity in patients with glioblastoma, however, clinical data on status epilepticus (SE) in these patients is sparse. We aimed to investigate the risk factors associated with the occurrence and adverse outcomes of SE in glioblastoma patients. We retrospectively analysed electronic medical records of patients with de-novo glioblastoma treated at our institution between 01/2006 and 01/2020 and collected data on patient, tumour, and SE characteristics. In the final cohort, 292/520 (56.2%) patients developed seizures, with 48 (9.4% of the entire cohort and 16.4% of patients with epilepsy, PWE) experiencing SE at some point during the course of their disease. SE was the first symptom of the tumour in 6 cases (1.2%) and the first manifestation of epilepsy in 18 PWE (6.2%). Most SE episodes occurred postoperatively (n=37, 77.1%). SE occurrence in PWE was associated with postoperative seizures and drug-resistant epilepsy. Adverse outcome (in-house mortality or admission to palliative care, 10/48 patients, 20.8%), was independently associated with higher status epilepticus severity score (STESS) and Charlson Comorbidity Index (CCI), but not tumour progression. 32/48 SE patients (66.7%) were successfully treated with first- and second-line agents, while escalation to third-line agents was successful in 6 (12.5%) cases. Our data suggests a link between the occurrence of SE, postoperative seizures, and drug-resistant epilepsy. Despite the dismal oncological prognosis, SE was successfully treated in 79.2% of the cases. Higher STESS and CCI were associated with adverse SE outcomes.