Predictors of early, recurrent, and intractable seizures in low-grade glioma

Jasmin Jo; Kathryn Nevel; Ryan Sutyla; Mark Smolkin; M Beatriz Lopes; David Schiff

doi:10.1093/nop/npaa054

Predictors of early, recurrent, and intractable seizures in low-grade glioma

Neurooncol Pract. 2020 Aug 29;8(1):40-47. doi: 10.1093/nop/npaa054. eCollection 2021 Feb.

Authors

Jasmin Jo¹, Kathryn Nevel¹, Ryan Sutyla², Mark Smolkin³, M Beatriz Lopes⁴, David Schiff⁵

Affiliations

¹ Department of Neurology, University of Virginia, Charlottesville, Virginia.
² School of Medicine, University of Virginia, Charlottesville, Virginia.
³ Department of Public Health Sciences, Division of Biostatistics, University of Virginia, Charlottesville, Virginia.
⁴ Department of Pathology, Division of Neuropathology, University of Virginia, Charlottesville, Virginia.
⁵ Department of Neurology, Division of Neuro-Oncology, University of Virginia, Charlottesville, Virginia.

Abstract

Background: Seizures are common among patients with low-grade glioma (LGG) and can significantly affect morbidity. We sought to determine the association between the clinical and molecular factors with seizure incidence and refractoriness in LGG patients.

Methods: We conducted a retrospective review at the University of Virginia in patients with LGG (World Health Organization, WHO Grade II) evaluated between 2002 and 2015. Descriptive statistics were calculated for variables of interest, and the Kaplan-Meier method was used to estimate survival curves, which were compared with the log-rank test.

Results: A total of 291 patients were included; 254 had molecular testing performed for presence of an isocitrate dehydrogenase (IDH) mutation and/or 1p/19q codeletion. Sixty-eight percent of patients developed seizures prior to LGG diagnosis; 41% of all patients had intractable seizures. Using WHO 2016 integrated classification, there was no significant difference in seizure frequency during preoperative and postoperative periods or in developing intractable seizures, though a trend toward increased preoperative seizure incidence among patients with the IDH mutation was identified (P = .09). Male sex was significantly associated with higher seizure incidence during preoperative (P < .001) and postoperative periods (P < .001); men were also more likely to develop intractable seizures (P = .01).

Conclusions: Seizures are common among patients with LGG. Differences in preoperative or postoperative and intractable seizure rates by WHO 2016 classification were not detected. Our data showed a trend toward higher seizure incidence preoperatively in patients with IDH-mutant LGG. We describe a unique association between male sex and seizure incidence and intractability that warrants further study.

Keywords: IDH mutation; WHO 2016 classification; low-grade glioma; seizure.

© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.