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Seizures during the management of high-grade gliomas: clinical relevance to disease progression

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Abstract

This study was performed to evaluate the incidence of seizures with its implications on disease progression and the diagnostic value of post-ictal magnetic resonance images (MRI) during the management of high-grade gliomas (HGGs). A total of 406 consecutive patients with newly diagnosed HGGs were retrospectively reviewed. The incidence of seizures during the management was investigated. In patients who experienced a seizure, the causality between seizures and disease progression was assessed by pre-ictal, post-ictal (<1 month), and follow-up (<3 months) MRI. After a median follow-up of 17.4 months (range 0.1–88.3), seizures developed in 127 patients (31 %). Of the 127 patients, radiological progression at the post-ictal MRI was found in 83 patients (65 %) and the follow-up MRI confirmed progression in 79 patients (62 %). Four other patients (3 %) were shown to be progression-free. Among those without radiological progression at the post-ictal MRI, the follow-up MRI confirmed progression-free in 31 patients (24 %); however, 13 patients (10 %) revealed eventual progression. In the patients with a seizure, absence of preoperative seizures (p = 0.003), <95 % tumor resection (p = 0.001), and pre-ictal Karnofsky Performance Scale score ≤70 (p = 0.025) were significantly associated with disease progression. During the management of HGG, 31 % of patients experienced seizures; of these patients, 72 % harbored progressive disease. The post-ictal MRI is useful for detecting disease progression; however, there are pitfalls. Clinical settings should be considered together for diagnosing disease progression in patients with seizures.

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Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Education, Science and Technology (2012R1A1A2003779).

Conflict of interest

  None of the authors has any conflicts of interest to disclose.

Ethics Approval

  Ethics approval was provided by the Institutional Review Board of Seoul National University Hospital (H-1201-017-392) and Seoul National University Bundang Hospital (B-1201-143-106).

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehang-ro Jongno-gu, Seoul, 110-744, South Korea

    Young-Hoon Kim, Chul-Kee Park, Jung Ho Han, Chae-Yong Kim, Dong Gyu Kim & Hee-Won Jung

  2. Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, si, South Korea

    Young-Hoon Kim, Jung Ho Han & Chae-Yong Kim

  3. Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea

    Chul-Kee Park, Dong Gyu Kim & Hee-Won Jung

  4. Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea

    Tae Min Kim, Se-Hoon Lee & Dae Seog Heo

  5. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Seung Hong Choi

  6. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, si, South Korea

    Yu Jung Kim

  7. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, si, South Korea

    Byung Se Choi

  8. Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, si, South Korea

    In Ah Kim

  9. Department of Radiation Oncology, Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea

    Il Han Kim

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  1. Young-Hoon Kim
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  2. Chul-Kee Park
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  10. In Ah Kim
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Corresponding author

Correspondence to Chul-Kee Park.

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Kim, YH., Park, CK., Kim, T.M. et al. Seizures during the management of high-grade gliomas: clinical relevance to disease progression. J Neurooncol 113, 101–109 (2013). https://doi.org/10.1007/s11060-013-1094-6

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  • DOI: https://doi.org/10.1007/s11060-013-1094-6

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