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Early EEG hyperexcitability is associated with decreased survival in newly diagnosed IDH-wildtype glioma

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A Correction to this article was published on 06 July 2022

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Abstract

Purpose

The relationship between peritumoral neuronal activity, early onset clinical seizures, and glioma survival outcomes remains poorly understood. Hyperexcitability on continuous EEG in the peri-operative period was studied as a prognostic biomarker in patients with newly diagnosed IDH-wildtype diffuse glioma.

Methods

A retrospective observational cohort study was performed including adults with newly diagnosed diffuse glioma, absence of IDH1/2 mutations, and continuous EEG monitoring prior to chemoradiation and within 1 month of initial resection. EEG hyperexcitability was defined by the presence of lateralized periodic discharges and/or electrographic seizures. The primary outcome of overall survival was estimated using the Kaplan–Meier method and compared between groups using multivariate Cox proportional hazards model.

Results

There were 424 patients without continuous EEG and 32 with continuous EEG, of whom lateralized periodic discharges and/or electrographic seizures were seen in 17 (53%). Peri-operative EEG hyperexcitability was associated with decreased overall survival in multivariate analysis (median 12.5 [95% CI 6.2–25.6] months with hyperexcitability versus median 19.9 [95% CI 8.9–53.5] months without hyperexcitability, p = 0.043). Compared to patients without continuous EEG, overall survival was decreased in patients with hyperexcitability (p < 0.0001) and similar in patients without hyperexcitability (p = 0.193). Patients with and without hyperexcitability had similar rates of exposure to anti-seizure medication at baseline, and in long-term follow-up had no difference in number of medications required for seizure control.

Conclusions

These findings indicate the potential prognostic value of a clinical EEG biomarker of glioma aggressiveness prior to the initiation of chemoradiation.

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Acknowledgements

The authors would like to acknowledge the Dana-Farber Cancer Institute Oncology Data Retrieval System (OncDRS) for the aggregation, management, and delivery of the clinical and operational research data used in this project. The content is solely the responsibility of the authors.

Funding

This work was supported by the National Institutes of Health (Grant No. nih/NCI 2P50CA165962-06A1 Sub-Project 5140).

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Authors and Affiliations

  1. Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

    Steven Tobochnik & Jong Woo Lee

  2. Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA

    Emily Lapinskas, Jayne Vogelzang & Keith L. Ligon

  3. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Keith L. Ligon

  4. VA Boston Healthcare System, Boston, MA, USA

    Steven Tobochnik

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Contributions

ST conceived of the study. ST, JWL, and KLL contributed to the study design. ST, EL, and JV contributed to data collection and analysis. ST wrote the main manuscript text and prepared the figures. All authors reviewed and edited the manuscript.

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Correspondence to Steven Tobochnik.

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The original version of this article has been revised: Some brackets have been corrected in in the second sentence of the Results paragraph in the Abstract and in the second sentence of the subsection Prognostic value of EEG hyperexcitability in the Results section.

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Tobochnik, S., Lapinskas, E., Vogelzang, J. et al. Early EEG hyperexcitability is associated with decreased survival in newly diagnosed IDH-wildtype glioma. J Neurooncol 159, 211–218 (2022). https://doi.org/10.1007/s11060-022-04059-8

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  • DOI: https://doi.org/10.1007/s11060-022-04059-8

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