1
|
Li J, Long S, Zhang Y, Wei W, Yu S, Liu Q, Hui X, Li X, Wang Y. Molecular mechanisms and diagnostic model of glioma-related epilepsy. NPJ Precis Oncol 2024; 8:223. [PMID: 39363097 PMCID: PMC11450052 DOI: 10.1038/s41698-024-00721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 09/22/2024] [Indexed: 10/05/2024] Open
Abstract
Epilepsy is one of the most common symptoms in patients with gliomas; however, the mechanisms underlying its interaction are not yet clear. Moreover, epidemiological studies have not accurately identified patients with glioma-related epilepsy (GRE), and there is an urgent need to identify the molecular mechanisms and markers of its occurrence. We analyzed the demographics, transcriptome, whole-genome, and methylation sequences of 997 patients with glioma, to determine the genetic differences between glioma and GRE patients and to determine the upregulated molecular function, cellular composition, biological processes involved, signaling pathways, and immune cell infiltration. Twelve machine learning algorithms were refined into 113 combinatorial algorithms for building diagnostic recognition models. A total of 342 patients with GRE were identified with WHO grade 2 (174), grade 3 (107), and grade 4 (61). The mean age of the patients with GREs, with IDH mutations (n = 217 [63%]) and 1p19q non-codeletion (n = 169 [49%]), was 38 years old. GRE molecular functions were mainly passive transmembrane transporter protein activity, ion channel activity, and gated channel activity. Cellular components were enriched in the cation-channel and transmembrane transporter complexes. Cerebral cortical development regulates the membrane potential and synaptic organization as major biological processes. The signaling pathways mainly focused on cholinergic, GABAergic, and glutamatergic synapses. LASSO, combined with Random Forest, was the best diagnostic model and identified nine diagnostic genes. This study provides new insights and future perspectives for resolving the molecular mechanisms of GRE.
Collapse
Affiliation(s)
- Jinwei Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shengrong Long
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yang Zhang
- Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wei Wei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shuangqi Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Quan Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China.
| |
Collapse
|
2
|
Aboubakr O, Houillier C, Alentorn A, Choquet S, Dupont S, Mokhtari K, Leclercq D, Nichelli L, Kas A, Rozenblum L, Le Garff-Tavernier M, Hoang-Xuan K, Carpentier A, Mathon B. Epilepsy in Patients With Primary CNS Lymphoma: Prevalence, Risk Factors, and Prognostic Significance. Neurology 2024; 103:e209748. [PMID: 39116374 DOI: 10.1212/wnl.0000000000209748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is a common comorbidity of brain tumors; however, little is known about the prevalence, onset time, semiology, and risk factors of seizures in primary CNS lymphoma (PCNSL). Our objectives were to determine the prevalence of epilepsy in PCNSL, to identify factors associated with epilepsy, and to investigate the prognostic significance of seizures in PCNSL. METHODS We performed an observational, retrospective single-center study at a tertiary neuro-oncology center (2011-2023) including immunocompetent patients with PCNSL and no history of seizures. We collected clinical, imaging, and treatment data; seizure status over the course of PCNSL; and oncological and seizure outcome. The primary outcome was to determine the prevalence of epilepsy. Furthermore, we aimed to identify clinical, radiologic, and treatment-related factors associated with epilepsy. Univariate analyses were conducted using the χ2 test for categorical variables and unpaired t test for continuous variables. Predictors identified in the unadjusted analysis were included in backward stepwise logistic regression models. RESULTS We included 330 patients, 157 (47.6%) were male, median age at diagnosis was 68 years, and the median Karnofsky Performance Status score was 60. Eighty-three (25.2%) patients had at least 1 seizure from initial diagnosis to the last follow-up, 40 (12.1%) as the onset symptom, 16 (4.8%) during first line of treatment, 27 (8.2%) at tumor progression and 6 (1.8%) while in remission. Focal aware seizures were the most frequent seizure type, occurring in 43 (51.8%) patients. Seizure freedom under antiseizure medication was observed in 97.6% patients. Cortical contact (odds ratio [OR] 8.6, 95% CI 4.2-15.5, p < 0.001) and a higher proliferation index (OR 5.7, 95% CI 1.3-26.2, p = 0.02) were identified as independent risk factors of epilepsy. Patients with PCNSL and epilepsy had a significantly shorter progression-free survival (median progression-free survival 9.6 vs 14.1 months, adjusted hazard ratio 1.4, 95% CI 1.0-1.9, p = 0.03), but not a significantly shorter overall survival (17 vs 44.1 months, log-rank test, p = 0.09). DISCUSSION Epilepsy affects a quarter of patients with PCNSL, with half experiencing it at the time of initial presentation and potentially serving as a marker of disease progression. Further research is necessary to assess the broader applicability of these findings because they are subject to the constraints of a retrospective design and tertiary center setting.
Collapse
Affiliation(s)
- Oumaima Aboubakr
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Caroline Houillier
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Agusti Alentorn
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Sylvain Choquet
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Sophie Dupont
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Karima Mokhtari
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Delphine Leclercq
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Lucia Nichelli
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Aurelie Kas
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Laura Rozenblum
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Magali Le Garff-Tavernier
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Khê Hoang-Xuan
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alexandre Carpentier
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Bertrand Mathon
- From the Departments of Neurosurgery (O.A., A.C., B.M.), Neuro-Oncology (C.H., A.A., K.H.-X.), Hematology (S.C.), Epileptology (S.D.), Neuropathology (K.M.), Neuroradiology (D.L., L.N.), Nuclear Medicine (A.K., L.R.), and Biological Hematology (M.L.G.-T.), the Paris Brain Institute (ICM) (O.A., A.A., B.M.), LIB, INSERM U1146 (A.K., L.R.), INSERM U1127 (B.M.), CNRS UMR 7225 (B.M.), and GRC 23, Brain Machine Interface (A.C), La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| |
Collapse
|
3
|
Hinojosa J, Becerra V, Candela-Cantó S, Alamar M, Culebras D, Valencia C, Valera C, Rumiá J, Muchart J, Aparicio J. Extra-temporal pediatric low-grade gliomas and epilepsy. Childs Nerv Syst 2024:10.1007/s00381-024-06573-8. [PMID: 39191974 DOI: 10.1007/s00381-024-06573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 08/11/2024] [Indexed: 08/29/2024]
Abstract
Low-grade gliomas, especially glioneuronal tumors, are a common cause of epilepsy in children. Seizures associated with low-grade pediatric tumors are medically refractory and present a significant burden to patients. Often, morbidity and patients´ quality of life are determined rather by the control of seizures than the oncological process itself and the resolution of epilepsy represents an important part in the treatment of LGGs. The pathogenesis of tumor-related seizures in focal LGG tumors is multifactorial, and mechanisms differ probably among patients and tumor types. Pediatric low-grade tumors associated with epilepsy include a series of neoplasms that have a pure astrocytic or glioneuronal lineage. They are usually benign tumors with a neocortical localization typically in the temporal lobes, but also in other supratentorial locations. Gangliogliomas and dysembryoplastic neuroepithelial tumors (DNET) are the most common entities together with astrocytic gliomas (pilocytic astrocytomas and pleomorphic xanthoastrocytoma) and angiocentric gliomas, and dual pathology is found in up to 40% of glioneuronal tumors. The treatment of low-grade gliomas and associated epilepsy is based mainly on resection and the extent of surgery is the main predictor of postoperative seizure control in patients with a LGG. Long-term epilepsy-associated tumors (LEATs) tend to be well-circumscribed, and therefore, the chances for a complete resection and epilepsy control with a safe approach are very high. New treatments have emerged as alternatives to open microsurgical approaches, including laser thermal ablation or the use of BRAF inhibitors. Future advances in identifying seizure-related biomarkers and molecular tumor pathways will facilitate targeted treatment strategies that will have a deep impact both in oncologic and epilepsy outcomes.
Collapse
Affiliation(s)
- José Hinojosa
- Department of Neurosurgery, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain.
- Unit for Epilepsy Surgery, Member of ERN-EpiCARE, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain.
| | - Victoria Becerra
- Department of Neurosurgery, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Santiago Candela-Cantó
- Department of Neurosurgery, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
- Unit for Epilepsy Surgery, Member of ERN-EpiCARE, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Mariana Alamar
- Department of Neurosurgery, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Diego Culebras
- Department of Neurosurgery, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
- Unit for Epilepsy Surgery, Member of ERN-EpiCARE, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Carlos Valencia
- Department of Neurosurgery, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Carlos Valera
- Unit for Epilepsy Surgery, Member of ERN-EpiCARE, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Jordi Rumiá
- Department of Neurosurgery, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
- Department of Neurosurgery, Hospital Clinic Barcelona, C. de Villarroel, 170 08036, Barcelona, Spain
- Unit for Epilepsy Surgery, Member of ERN-EpiCARE, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Jordi Muchart
- Department of Neuroradiology, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
- Unit for Epilepsy Surgery, Member of ERN-EpiCARE, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| | - Javier Aparicio
- Unit for Epilepsy Surgery, Member of ERN-EpiCARE, Hospital Sant Joan de Déu, Pg. de Sant Joan de Déu, 2, 08950, Barcelona, Spain
| |
Collapse
|
4
|
Weld A, Dixon L, Anichini G, Patel N, Nimer A, Dyck M, O'Neill K, Lim A, Giannarou S, Camp S. Challenges with segmenting intraoperative ultrasound for brain tumours. Acta Neurochir (Wien) 2024; 166:317. [PMID: 39090435 PMCID: PMC11294268 DOI: 10.1007/s00701-024-06179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/22/2024] [Indexed: 08/04/2024]
Abstract
Objective - Addressing the challenges that come with identifying and delineating brain tumours in intraoperative ultrasound. Our goal is to both qualitatively and quantitatively assess the interobserver variation, amongst experienced neuro-oncological intraoperative ultrasound users (neurosurgeons and neuroradiologists), in detecting and segmenting brain tumours on ultrasound. We then propose that, due to the inherent challenges of this task, annotation by localisation of the entire tumour mass with a bounding box could serve as an ancillary solution to segmentation for clinical training, encompassing margin uncertainty and the curation of large datasets. Methods - 30 ultrasound images of brain lesions in 30 patients were annotated by 4 annotators - 1 neuroradiologist and 3 neurosurgeons. The annotation variation of the 3 neurosurgeons was first measured, and then the annotations of each neurosurgeon were individually compared to the neuroradiologist's, which served as a reference standard as their segmentations were further refined by cross-reference to the preoperative magnetic resonance imaging (MRI). The following statistical metrics were used: Intersection Over Union (IoU), Sørensen-Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD). These annotations were then converted into bounding boxes for the same evaluation. Results - There was a moderate level of interobserver variance between the neurosurgeons [ I o U : 0.789 , D S C : 0.876 , H D : 103.227 ] and a larger level of variance when compared against the MRI-informed reference standard annotations by the neuroradiologist, mean across annotators [ I o U : 0.723 , D S C : 0.813 , H D : 115.675 ] . After converting the segments to bounding boxes, all metrics improve, most significantly, the interquartile range drops by [ I o U : 37 % , D S C : 41 % , H D : 54 % ] . Conclusion - This study highlights the current challenges with detecting and defining tumour boundaries in neuro-oncological intraoperative brain ultrasound. We then show that bounding box annotation could serve as a useful complementary approach for both clinical and technical reasons.
Collapse
Affiliation(s)
- Alistair Weld
- Hamlyn Centre, Imperial College London, Exhibition Rd, London, SW7 2AZ, UK.
| | - Luke Dixon
- Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, W6 8RF, UK
| | - Giulio Anichini
- Department of Neurosurgery, Charing Cross Hospital, Fulham Palace Rd, W6 8RF, London, UK
| | - Neekhil Patel
- Department of Neurosurgery, Charing Cross Hospital, Fulham Palace Rd, W6 8RF, London, UK
| | - Amr Nimer
- Department of Neurosurgery, Charing Cross Hospital, Fulham Palace Rd, W6 8RF, London, UK
| | - Michael Dyck
- School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, Garching, 85748, Germany
| | - Kevin O'Neill
- Department of Neurosurgery, Charing Cross Hospital, Fulham Palace Rd, W6 8RF, London, UK
| | - Adrian Lim
- Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, W6 8RF, UK
| | - Stamatia Giannarou
- Hamlyn Centre, Imperial College London, Exhibition Rd, London, SW7 2AZ, UK
| | - Sophie Camp
- Department of Neurosurgery, Charing Cross Hospital, Fulham Palace Rd, W6 8RF, London, UK
| |
Collapse
|
5
|
Ng S, Moritz-Gasser S, Lemaitre AL, Duffau H, Herbet G. Multivariate mapping of low-resilient neurocognitive systems within and around low-grade gliomas. Brain 2024; 147:2718-2731. [PMID: 38657204 DOI: 10.1093/brain/awae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/18/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Accumulating evidence suggests that the brain exhibits a remarkable capacity for functional compensation in response to neurological damage, a resilience potential that is deeply rooted in the malleable features of its underlying anatomofunctional architecture. This propensity is particularly exemplified by diffuse low-grade glioma, a subtype of primary brain tumour. However, functional plasticity is not boundless, and surgical resections directed at structures with limited neuroplasticity can lead to incapacitating impairments. Yet, maximizing diffuse low-grade glioma resections offers substantial oncological benefits, especially when the resection extends beyond the tumour margins (i.e. supra-tumour or supratotal resection). In this context, the primary objective of this study was to identify which cerebral structures were associated with less favourable cognitive outcomes after surgery, while accounting for intra-tumour and supra-tumour features of the surgical resections. To achieve this objective, we leveraged a unique cohort of 400 patients with diffuse low-grade glioma who underwent surgery with awake cognitive mapping. Patients benefitted from a neuropsychological assessment consisting of 18 subtests administered before and 3 months after surgery. We analysed changes in performance and applied topography-focused and disconnection-focused multivariate lesion-symptom mapping using support vector regressions, in an attempt to capture resected cortico-subcortical structures less amenable to full cognitive compensation. The observed changes in performance were of a limited magnitude, suggesting an overall recovery (13 of 18 tasks recovered fully despite a mean resection extent of 92.4%). Nevertheless, lesion-symptom mapping analyses revealed that a lack of recovery in picture naming was linked to damage in the left inferior temporal gyrus and inferior longitudinal fasciculus. Likewise, for semantic fluency abilities, an association was established with damage to the left precuneus/posterior cingulate. For phonological fluency abilities, the left dorsomedial frontal cortex and the frontal aslant tract were implicated. Moreover, difficulties in spatial exploration were associated with injury to the right dorsomedial prefrontal cortex and its underlying connectivity. An exploratory analysis suggested that supra-tumour resections were associated with a less pronounced recovery following specific resection patterns, such as supra-tumour resections of the left uncinate fasciculus (picture naming), the left corticostriatal tract and the anterior corpus callosum (phonological fluency), the hippocampus and parahippocampus (episodic memory) and the right frontal-mesial areas (visuospatial exploration). Collectively, these patterns of results shed new light on both low-resilient neural systems and the prediction of cognitive recovery following glioma surgery. Furthermore, they indicate that supra-tumour resections were only occasionally less well tolerated from a cognitive viewpoint. In doing so, they have deep implications for surgical planning and rehabilitation strategies.
Collapse
Affiliation(s)
- Sam Ng
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 34094 Montpellier, France
| | - Sylvie Moritz-Gasser
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 34094 Montpellier, France
| | - Anne-Laure Lemaitre
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Laboratoire Praxiling, UMR 5267, CNRS, Université Paul Valéry-Montpellier 3, Bâtiment de recherche Marc Bloch, 34090 Montpellier, France
| | - Hugues Duffau
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 34094 Montpellier, France
| | - Guillaume Herbet
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Laboratoire Praxiling, UMR 5267, CNRS, Université Paul Valéry-Montpellier 3, Bâtiment de recherche Marc Bloch, 34090 Montpellier, France
- Faculté de médecine, campus ADV, Université de Montpellier, 34090 Montpellier, France
- Institut Universitaire de France, 75231 Paris CEDEX 05, France
| |
Collapse
|
6
|
Aminuddin L, Wan Hitam WH, Mohamad SA, Abdul Halim S, Sapiai NA. Intra-axial Cortical-Based Tumour Presented as Homonymous Hemianopia in a Young Patient: A Diagnostic Dilemma. Cureus 2024; 16:e64963. [PMID: 39161507 PMCID: PMC11331184 DOI: 10.7759/cureus.64963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
Intra-axial cortical-based tumours are rare tumours affecting children and young adults. These tumours can be classified as either low-grade or high-grade, depending on their aggressiveness and rate of growth. We report a case of homonymous hemianopia secondary to an intra-axial cortical-based tumour in a young patient. A 26-year-old lady presented with bilateral blurring of vision for three weeks associated with a headache. Visual acuity was 6/6 in both eyes. Bilateral optic nerve functions were normal. The Humphrey visual field test showed left-homonymous hemianopia. A CT scan and MRI of the brain revealed an intra-axial cortical-based tumor. Differential diagnoses include pleomorphic xanthoastrocytoma (PXA), ganglioglioma, oligodendroglioma, and dysembryoplastic neuroepithelial tumour (DNET). The patient was treated conservatively and closely monitored through clinic follow-up.
Collapse
Affiliation(s)
- Luqmanhaqim Aminuddin
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Wan-Hazabbah Wan Hitam
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Shahidatul-Adha Mohamad
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Sanihah Abdul Halim
- Brain and Behaviour Cluster, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Internal Medicine (Neurology) School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Nur Asma Sapiai
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| |
Collapse
|
7
|
Maciel CB, Busl KM. Neuro-oncologic Emergencies. Continuum (Minneap Minn) 2024; 30:845-877. [PMID: 38830073 DOI: 10.1212/con.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Neuro-oncologic emergencies have become more frequent as cancer remains one of the leading causes of death in the United States, second only to heart disease. This article highlights key aspects of epidemiology, diagnosis, and management of acute neurologic complications in primary central nervous system malignancies and systemic cancer, following three thematic classifications: (1) complications that are anatomically or intrinsically tumor-related, (2) complications that are tumor-mediated, and (3) complications that are treatment-related. LATEST DEVELOPMENTS The main driver of mortality in patients with brain metastasis is systemic disease progression; however, intracranial hypertension, treatment-resistant seizures, and overall decline due to increased intracranial burden of disease are the main factors underlying neurologic-related deaths. Advances in the understanding of tumor-specific characteristics can better inform risk stratification of neurologic complications. Following standardized grading and management algorithms for neurotoxic syndromes related to newer immunologic therapies is paramount to achieving favorable outcomes. ESSENTIAL POINTS Neuro-oncologic emergencies span the boundaries of subspecialties in neurology and require a broad understanding of neuroimmunology, neuronal hyperexcitability, CSF flow dynamics, intracranial compliance, and neuroanatomy.
Collapse
|
8
|
Fairclough S, Chumas P, Goodden J, Maguire M, Mathew RK. Motor seizures confer overall survival benefit in who grade 2 glioma. Epilepsia 2024; 65:1679-1686. [PMID: 38506645 DOI: 10.1111/epi.17956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The prevalence of epilepsy in World Health Organization (WHO) grade 2 glioma is high, with seizures being the presenting symptom in 60%-90%. We explore the epidemiology of seizures in this patient population in a regional neurosurgical center. METHODS Electronic health records of patients with histologically-proven WHO grade 2 glioma (n = 228) were reviewed between 1997 and 2021, with data collected including patient demographics, epilepsy prevalence, and seizure semiology. The influence of seizure type on overall survival was calculated using a Cox proportional hazards model. RESULTS Overall, 197 of 228 patients (86.4%) were diagnosed with epilepsy-either at presentation or during the course of their disease. Male patients were more likely than female patients to be diagnosed with epilepsy (91.1% vs 77.1%, p = .003) and, in those with epilepsy, more likely to experience at least one focal to bilateral tonic-clonic seizure (69.4% vs 54.1%, p = .05). Patients with left-sided tumors were twice as likely to have experienced a focal to bilateral tonic-clonic seizure (p = .02, odds ratio [OR] = .47). Predominantly experiencing seizures with motor activity appeared to confer better overall survival, with a 65% decrease in the risk of death 10 years post diagnosis (hazard ratio [HR] = .35, p = .02). This is despite accounting for previously described prognostic markers including tumor histology/genetics, time from diagnosis to surgery, and the extent of tumor resection. SIGNIFICANCE Motor seizure activity is a frequent feature in WHO grade 2 glioma and appears to confer a survival benefit regardless of histology or surgical factors. Seizures due to dominant hemisphere tumors may be more likely to propagate and cause bilateral tonic-clonic activity.
Collapse
Affiliation(s)
- Sam Fairclough
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - John Goodden
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - Melissa Maguire
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| |
Collapse
|
9
|
Bruno F, Pellerino A, Conti Nibali M, Pronello E, Cofano F, Rossi M, Levis M, Bertero L, Soffietti R, Cassoni P, Garbossa D, Bello L, Rudà R. Association of Clinical, Tumor, and Treatment Characteristics With Seizure Control in Patients With IDH1/2-Mutant Lower-Grade Glioma. Neurology 2024; 102:e209352. [PMID: 38684041 DOI: 10.1212/wnl.0000000000209352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with IDH1/2-mutant lower-grade glioma have a high frequency of seizures. We aimed to investigate the correlations between seizures and tumor/patient characteristics and the impact of surgery and adjuvant treatments (AT) on seizure control along the disease trajectory. METHODS We retrospectively included patients with IDH1/2-mutant lower-grade glioma who underwent surgery at the neurosurgery divisions of the University of Turin and Milan and were treated at the Division of Neuro-Oncology of Turin. Inclusion criteria were a diagnosis according to the 2021 WHO Classification and presentation with seizures; exclusion criteria were presence of CDKN2A/B homozygous deletion, intense/ring contrast enhancement on MRI at presentation, and small tissue biopsy. We evaluated seizure freedom for 2 months after surgery, 6 months from starting observation or AT, at recurrence, and for 6 months after treatments of recurrence. RESULTS We included 150 patients. There were 77 (51%) and 31 (21%) patients with IDH-mutant/1p19q-codeleted grade 2 and 3 oligodendroglioma and 30 (20%) and 12 (8%) with IDH-mutant grade 2 and 3 astrocytoma, respectively. Total resection was accomplished in 68 (45%). Seventy-five patients (50%) received AT while the remaining 75 were observed with MRI. After 6 months after AT, 28 of 29 patients (96.5%) displayed seizure reduction, 5 of 28 (18%) being seizure-free. 66 of 124 patients (53%) had seizures at recurrence. After 6 months after second-line treatments, 60 of 66 patients (91%) had seizure reduction, 11 (17%) being seizure-free. In multivariable analyses, grade 3 histology positively correlated with seizure freedom at 2 months after surgery (OR 3.5, 1.4-8.9, p = 0.008), 6 months after AT (OR 9.0, 1.5-54.9, p = 0.017), and 6 months after treatment of recurrence (OR 4.9, 1.5-16.5, p = 0.009). Adjuvant radiotherapy reduced seizures at recurrence in a univariate analysis (OR 0.14, 0.03-0.7, p = 0.020). Patients with seizure freedom after surgery and AT displayed longer progression-free survival (PFS) (65, 24.5-105, vs 48 months, 32-63.5, p = 0.037). DISCUSSION This study analyzed seizure control in patients with IDH1/2-mutant lower-grade glioma across multiple time points. Grade 3 correlated with better seizure control throughout the entire disease trajectory, and seizure freedom after surgery and AT correlated with a longer PFS regardless of tumor grade. These results could serve as an external control arm in clinical trials evaluating the efficacy on seizures of antitumor agents in patients with IDH-mutant lower-grade glioma.
Collapse
Affiliation(s)
- Francesco Bruno
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Alessia Pellerino
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Marco Conti Nibali
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Edoardo Pronello
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Fabio Cofano
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Marco Rossi
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Mario Levis
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Luca Bertero
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Riccardo Soffietti
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Paola Cassoni
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Diego Garbossa
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Lorenzo Bello
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Roberta Rudà
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| |
Collapse
|
10
|
Schneider M, Potthoff AL, Karpel-Massler G, Schuss P, Siegelin MD, Debatin KM, Duffau H, Vatter H, Herrlinger U, Westhoff MA. The Alcatraz-Strategy: a roadmap to break the connectivity barrier in malignant brain tumours. Mol Oncol 2024. [PMID: 38567664 DOI: 10.1002/1878-0261.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/19/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
In recent years, the discovery of functional and communicative cellular tumour networks has led to a new understanding of malignant primary brain tumours. In this review, the authors shed light on the diverse nature of cell-to-cell connections in brain tumours and propose an innovative treatment approach to address the detrimental connectivity of these networks. The proposed therapeutic outlook revolves around three main strategies: (a) supramarginal resection removing a substantial portion of the communicating tumour cell front far beyond the gadolinium-enhancing tumour mass, (b) morphological isolation at the single cell level disrupting structural cell-to-cell contacts facilitated by elongated cellular membrane protrusions known as tumour microtubes (TMs), and (c) functional isolation at the single cell level blocking TM-mediated intercellular cytosolic exchange and inhibiting neuronal excitatory input into the malignant network. We draw an analogy between the proposed therapeutic outlook and the Alcatraz Federal Penitentiary, where inmates faced an impassable sea barrier and experienced both spatial and functional isolation within individual cells. Based on current translational efforts and ongoing clinical trials, we propose the Alcatraz-Strategy as a promising framework to tackle the harmful effects of cellular brain tumour networks.
Collapse
Affiliation(s)
- Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Germany
- Brain Tumour Translational Research Group, University Hospital Bonn, Germany
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, Germany
- Brain Tumour Translational Research Group, University Hospital Bonn, Germany
| | | | - Patrick Schuss
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Germany
| | - Markus D Siegelin
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Germany
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, France
- Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," National Institute for Health and Medical Research (INSERM), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, France
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Germany
- Brain Tumour Translational Research Group, University Hospital Bonn, Germany
| | - Ulrich Herrlinger
- Brain Tumour Translational Research Group, University Hospital Bonn, Germany
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Germany
| | - Mike-Andrew Westhoff
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Germany
| |
Collapse
|
11
|
Nandoliya KR, Thirunavu V, Ellis E, Dixit K, Tate MC, Drumm MR, Templer JW. Pre-operative predictors of post-operative seizure control in low-grade glioma: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:94. [PMID: 38411788 DOI: 10.1007/s10143-024-02329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
As many as 80% of low-grade gliomas (LGGs) present with seizures, negatively impacting quality of life. While seizures are associated with gliomas regardless of grade, the importance of minimizing impact of seizures for patients with low grade tumors cannot be understated given the prolonged survival period in this population. The objective of this systematic review and meta-analysis was to summarize existing literature and identify factors associated with post-operative seizure control (defined as Engel I classification) in patients with LGGs, with a focus on pre-operative factors. Patient data extracted include tumor location and histology, pre-operative anti-seizure medication use, extent of resection (EOR), adjuvant treatment, pre-operative seizure type, duration, and frequency, and post-operative Engel classification. A random-effects model was used to calculate the effects of EOR, pre-operative seizure duration, adjuvant radiation, and adjuvant chemotherapy on post-operative seizure control. The effect of tumor location and histology on post-operative Engel I classification was determined using contingency analyses. Thirteen studies including 1628 patients with seizures were included in the systematic review. On meta-analyses, Engel I classification was associated with pre-operative seizure type (OR = 0.79 (0.63-0.99), p = 0.0385, focal versus generalized), frontal lobe LGGs (OR = 1.5 (1.1-2.0), p = 0.0195), and EOR (OR (95% CI) = 4.5 (2.3-6.7), p < 0.0001 gross-total versus subtotal). Pre-operative seizure duration less than one year, adjuvant radiation, adjuvant chemotherapy, and tumor histology were not associated with achieving Engel I classification. In addition to the known effects of EOR, Engel I classification is less likely to be achieved in patients with focal pre-operative seizures and more likely to be achieved in patients with frontal lobe LGGs.
Collapse
Affiliation(s)
- Khizar R Nandoliya
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Erin Ellis
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Karan Dixit
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Michael R Drumm
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica W Templer
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA.
| |
Collapse
|
12
|
Peters KB, Templer J, Gerstner ER, Wychowski T, Storstein AM, Dixit K, Walbert T, Melnick K, Hrachova M, Partap S, Ullrich NJ, Ghiaseddin AP, Mrgula M. Discontinuation of Antiseizure Medications in Patients With Brain Tumors. Neurology 2024; 102:e209163. [PMID: 38290092 DOI: 10.1212/wnl.0000000000209163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024] Open
Abstract
Patients with brain tumors will experience seizures during their disease course. While providers can use antiseizure medications to control these events, patients with brain tumors can experience side effects, ranging from mild to severe, from these medications. Providers in subspecialties such as neurology, neuro-oncology, neurosurgery, radiation oncology, and medical oncology often work with patients with brain tumor to balance seizure control and the adverse toxicity of antiseizure medications. In this study, we sought to explore the problem of brain tumor-related seizures/epilepsy in the context of how and when to consider antiseizure medication discontinuation. Moreover, we thoroughly evaluate the literature on antiseizure medication discontinuation for adult and pediatric patients and highlight recommendations relevant to patients with both brain tumors and seizures.
Collapse
Affiliation(s)
- Katherine B Peters
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Jessica Templer
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Elizabeth R Gerstner
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Thomas Wychowski
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Anette M Storstein
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Karan Dixit
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Tobias Walbert
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Kaitlyn Melnick
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Maya Hrachova
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Sonia Partap
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Nicole J Ullrich
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Ashley P Ghiaseddin
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| | - Maciej Mrgula
- From the Departments of Neurosurgery and Neurology (K.B.P.), Duke University Medical Center, Durham, NC; Department of Neurology (J.T., K.D.), Northwestern University, Chicago, IL; Neurology (E.R.G.), Massachusetts General Hospital, Boston; Department of Neurology (T. Wychowski), University of Rochester Medical Center, Rochester, NY; Department of Neurology (A.M.S.), Haukeland University Hospital, Bergen, Norway; Departments of Neurology and Neurosurgery (T. Walbert), Henry Ford Health, Wayne State University and Michigan State University, Detroit; Neurosurgery (K.M., A.P.G.), University of Florida, Gainesville; Neurosurgery (M.H.), Oklahoma University, Oklahoma City; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Neurology (N.J.U.), Boston Children's Hospital, MA; and Neurology (M.M.), Mayo Clinic, Phoenix, AZ
| |
Collapse
|
13
|
Barberis M, Poisson I, Prévost-Tarabon C, Letrange S, Froelich S, Thirion B, Mandonnet E. Verbal fluency predicts work resumption after awake surgery in low-grade glioma patients. Acta Neurochir (Wien) 2024; 166:88. [PMID: 38372820 DOI: 10.1007/s00701-024-05971-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Resuming professional activity after awake surgery for diffuse low-grade glioma (DLGG) is an important goal, which is not reached in every patient. Cognitive deficits can occur and persist after surgery. In this study, we analyzed the impact of mild cognitive impairments on the work resumption. METHODS Fifty-four surgeries (including five redo surgeries) performed between 2012 and 2020 for grade 2 (45) and 3 (nine) DLGG in 49 professionally active patients (mean age 40 [range 23-58.) were included. We retrospectively extracted the results of semantic and phonemic verbal fluency tests from preoperative and 4-month postoperative cognitive assessments. Patients were interviewed about their working life after surgery, between April and June 2021. RESULTS Patients (85%) returned to work, most within 3 to 6 months. Patients (76%) reported subjective complaints (primarily fatigue). Self-reported symptoms and individual and clinical variables had no impact on the work resumption. Late-postoperative average Z-scores in verbal fluency tasks were significantly lower than preoperative for the entire cohort (Wilcoxon test, p < 0.001 for semantic and p = 0.008 for phonemic fluency). The decrease in Z-scores was significantly greater (Mann Whitney U-test, semantic, p = 0.018; phonemic, p = 0.004) in the group of patients who did not return to work than in the group of patients who did. CONCLUSION The proportion of patients returning to work was comparable to similar studies. A decrease in verbal fluency tasks could predict the inability to return to work.
Collapse
Affiliation(s)
- Marion Barberis
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France.
- UMR 7225, Frontlab, Paris Brain Institute, CNRS, INSERM U1127, 75013, Paris, France.
| | - Isabelle Poisson
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
| | | | - Sophie Letrange
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
| | - Sébastien Froelich
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
- Université de Paris Cité, 75010, Paris, France
| | | | - Emmanuel Mandonnet
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
- Université de Paris Cité, 75010, Paris, France
- UMR 7225, Frontlab, Paris Brain Institute, CNRS, INSERM U1127, 75013, Paris, France
| |
Collapse
|
14
|
Tran S, Lapidus A, Neal A, Peters KB, Gately L, Ameratunga M. A systematic review of the impact of brain tumours on risk of motor vehicle crashes. J Neurooncol 2024; 166:395-405. [PMID: 38321326 PMCID: PMC10876497 DOI: 10.1007/s11060-024-04586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Brain tumours are associated with neurocognitive impairments that are important for safe driving. Driving is vital to maintaining patient autonomy, despite this there is limited research on driving capacity amongst patients with brain tumours. The purpose of this review is to examine MVC risk in patients with brain tumours to inform development of clearer driving guidelines. METHODS A systematic review was performed using Medline and EMBASE. Observational studies were included. The outcome of interest was MVC or measured risk of MVC in patients with benign or malignant brain tumours. Descriptive analysis and synthesis without meta-analysis were used to summarise findings. A narrative review of driving guidelines from Australia, United Kingdom and Canada was completed. RESULTS Three studies were included in this review. One cohort study, one cross-sectional study and one case-control study were included (19,135 participants) across United States and Finland. One study evaluated the incidence of MVC in brain tumour patients, revealing no difference in MVC rates. Two studies measured MVC risk using driving simulation and cognitive testing. Patients found at higher risk of MVC had greater degrees of memory and visual attention impairments. However, predictive patient and tumour characteristics of MVC risk were heterogeneous across studies. Overall, driving guidelines had clear recommendations on selected conditions like seizures but were vague surrounding neurocognitive deficits. CONCLUSION Limited data exists regarding driving behaviour and MVC incidence in brain tumour patients. Existing guidelines inadequately address neurocognitive complexities in this group. Future studies evaluating real-world data is required to inform development of more applicable driving guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2023 CRD42023434608.
Collapse
Affiliation(s)
- Sophie Tran
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Adam Lapidus
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Andrew Neal
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | | | - Lucy Gately
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute for Medical Research, The University of Melbourne, Melbourne, VIC, Australia
| | - Malaka Ameratunga
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
15
|
Pallud J, Roux A, Moiraghi A, Aboubakr O, Elia A, Guinard E, Oppenheim C, Tauziede-Espariat A, Parraga E, Gavaret M, Chrètien F, Huberfeld G, Zanello M. Characteristics and Prognosis of Tumor-Related Epilepsy During Tumor Evolution in Patients With IDH Wild-Type Glioblastoma. Neurology 2024; 102:e207902. [PMID: 38165369 PMCID: PMC10834129 DOI: 10.1212/wnl.0000000000207902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Tumor-related epilepsy is a well-known symptom of glioblastoma. However, the particular characteristics of epileptic seizures related to glioblastoma, isocitrate dehydrogenase (IDH)-wild-type is almost unexplored longitudinally during the whole course of the disease. We assessed tumor-related epilepsy and seizure control during tumor evolution and the prognostic significance of tumor-related epilepsy. METHODS We performed an observational, retrospective single-center study at one tertiary referral neuro-oncology surgical center (2000-2020). We included adult patients treated for a newly diagnosed supratentorial glioblastoma, IDH-wild-type with available preoperative and postoperative MRI and with available epileptic seizure status at diagnosis. To determine factors associated with tumor-related epilepsy or seizure control, univariate analyses were performed using the χ2 or Fisher exact tests for categorical variables and the unpaired t test or Mann-Whitney rank-sum test for continuous variables. Predictors associated with tumor-related epilepsy and seizure control in unadjusted analysis were entered into backward stepwise logistic regression models. RESULTS One thousand six patients were enrolled. The cumulative incidence of tumor-related epilepsy increased during tumor evolution (33.1% at diagnosis, 44.7% after oncologic treatment, 52.4% at progression, and 51.8% at the end-of-life phase) and is related to tumor features (cortex involvement, no necrosis, and small volume). Uncontrolled epileptic seizures increased during tumor evolution (20.1% at diagnosis, 32.0% after oncologic treatment, 46.7% at progression, and 41.1% at the end-of-life phase). Epileptic seizure control after oncologic treatment was related to seizure features (uncontrolled before oncologic treatment and focal-to-bilateral tonic-clonic seizures) and to the extent of resection. Epileptic seizure control at tumor progression was related to seizure features (presence at diagnosis and uncontrolled after oncologic treatment) and to the time to progression. Tumor-related epilepsy at diagnosis was a predictor of a longer overall survival (adjusted hazard ratio, 0.78; 95% CI 0.67-0.90; p < 0.001) independent of age, Karnofsky Performance Status score, tumor location and volume, extent of resection, standard combined chemoradiotherapy, levetiracetam use, and MGMT promoter methylation. DISCUSSION The progression of tumor-related epilepsy with the evolution of glioblastoma, IDH-wild-type and the effects of surgery on seizure control argue for proper antiseizure medication and maximal safe resection. Tumor-related epilepsy is an independent predictor of a longer survival.
Collapse
Affiliation(s)
- Johan Pallud
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Alexandre Roux
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Alessandro Moiraghi
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Oumaima Aboubakr
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Angela Elia
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Eléonore Guinard
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Catherine Oppenheim
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Arnault Tauziede-Espariat
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Eduardo Parraga
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Martine Gavaret
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Fabrice Chrètien
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Gilles Huberfeld
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Marc Zanello
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| |
Collapse
|
16
|
Kivioja T, Posti JP, Sipilä J, Rauhala M, Frantzén J, Gardberg M, Rahi M, Rautajoki K, Nykter M, Vuorinen V, Nordfors K, Haapasalo H, Haapasalo J. Motor dysfunction as a primary symptom predicts poor outcome: multicenter study of glioma symptoms. Front Oncol 2024; 13:1305725. [PMID: 38239655 PMCID: PMC10794640 DOI: 10.3389/fonc.2023.1305725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Background and objectives The objectives of this study were to investigate the prognostic value of primary symptoms and leading symptoms in adult patients with diffuse infiltrating glioma and to provide a clinical perspective for evaluating survival. Methods This study included a retrospective cohort from two tertiary university hospitals (n = 604, 2006-2013, Tampere University Hospital and Turku University Hospital) and a prospective cohort (n = 156, 2014-2018, Tampere University Hospital). Preoperative symptoms were divided into primary and leading symptoms. Results were validated with the newer WHO 2021 classification criteria. Results The most common primary symptoms were epileptic seizure (30.8% retrospective, 28.2% prospective), cognitive disorder (13.2% retrospective, 16.0% prospective), headache (8.6% retrospective, 12.8% prospective), and motor paresis (7.0% retrospective, 7.1% prospective). Symptoms that predicted better survival were epileptic seizure and visual or other sense-affecting symptom in the retrospective cohort and epileptic seizure and headache in the prospective cohort. Predictors of poor survival were cognitive disorder, motor dysfunction, sensory symptom, tumor hemorrhage, speech disorder and dizziness in the retrospective cohort and cognitive disorder, motor dysfunction, sensory symptom, and dizziness in the prospective cohort. Motor dysfunction served as an independent predictor of survival in a multivariate model (OR = 1.636). Conclusion Primary and leading symptoms in diffuse gliomas are associated with prognoses in retrospective and prospective settings. Motor paresis was an independent prognostic factor for poor survival in multivariate analysis for grade 2-4 diffuse gliomas, especially in glioblastomas.
Collapse
Affiliation(s)
- Tomi Kivioja
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Jussi P. Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Sipilä
- Department of Neurology, Siun Sote, North Karelia Central Hospital, Joensuu, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Minna Rauhala
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Janek Frantzén
- Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria Gardberg
- Turku University Hospital, Tyks Laboratories, Pathology and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Melissa Rahi
- Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Kirsi Rautajoki
- Prostate Cancer Research Center, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere, Finland
| | - Matti Nykter
- Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere, Finland
| | - Ville Vuorinen
- Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Hannu Haapasalo
- Fimlab Laboratories Ltd., Tampere University Hospital, Tampere, Finland
| | - Joonas Haapasalo
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
- Fimlab Laboratories Ltd., Tampere University Hospital, Tampere, Finland
| |
Collapse
|
17
|
Milior G, Di Chiano M, Morin-Brureau M. Specificities of Living Human Microglial Cells. ADVANCES IN NEUROBIOLOGY 2024; 37:569-578. [PMID: 39207713 DOI: 10.1007/978-3-031-55529-9_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Microglia are macrophages residing in the central nervous system, where they perform immune surveillance, synaptic remodeling, neurogenesis, and monitor signals arising from brain injuries or potential pathogens.Commonly, rodent models are used for studying microglia because of the available transgenic mouse lines in which specific genetic manipulations are successfully accomplished. However, human and rodents microglia showed significant differences, which are reflected in different morphological and functional properties. These differences are in genetic and transcriptomic, but also in the expression of signaling molecules and age-associated changes.Several strategies are available to study human microglia, as using surgical brain resections from epileptic and tumoral tissues and from post mortem brain samples. In addition, the generation of human-induced pluripotent stem cells (hPSCs) and the possibility to differentiate them in microglia-like cells provide unique opportunities to compare microglia functions between rodents' and human brain.The use of human ex vivo and in vitro brain models allows the study of human microglia, mimicking in vivo conditions. This will be useful for a better understanding of the real live behavior and functions of microglia in the human brain. This chapter aims to highlight significant similarities and differences between human and rodent microglia in order to re-evaluate mouse models of different human brain disorders, proposing the use of in vitro and ex vivo human brain models.Studies on living human microglia in the brain may help to define divergences from animal models and to improve clinical interventions to treat brain pathologies, using alternatives targets.
Collapse
Affiliation(s)
- Giampaolo Milior
- Center for Interdisciplinary Research in Biology, College de France, CNRS, INSERM, Université PSL, Paris, France.
| | - Mariagiovanna Di Chiano
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Melanie Morin-Brureau
- INSERM, Sorbonne University, UMRS 938 Saint-Antoine Research Center, Immune System and Neuroinflammation Laboratory, Hôpital Saint-Antoine, Paris, France
| |
Collapse
|
18
|
Papadopoulou A, Kumar NS. Prognostic Factors and Resectability Predictors in Insular Gliomas: A Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2024; 85:74-87. [PMID: 37619597 PMCID: PMC10764153 DOI: 10.1055/s-0043-1769128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Insular gliomas (INGs) remain a surgically intimidating glioma subgroup encased by eloquent cortical parcels and white matter language tracts, and traversed by multiple middle cerebral artery branches. The predictive power of prognostic factors affecting overall survival (OS), progression-free survival (PFS), and resectability of INGs remain disputed. This comprehensive systematic review analyses prognostic factors and resectability predictors of INGs substantiating pragmatic management options. MATERIALS AND METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Cochrane Handbook of Systematic Reviews of Interventions guidelines. The PubMed, MEDLINE, and Embase databases were searched in April 2022. All clinical studies with ≥10 patients harboring INGs with any intervention and reporting predictors of OS, PFS, and tumor resectability in INGs were included. Molecular ING prognosticators were also included. Studies combining insular and other gliomas analysis, case studies, experimental and animal studies, conference abstracts, letters to the editor, and articles in other languages were excluded. RESULTS Of the 2,384 articles returned, 27 fulfilled the inclusion criteria totaling 1,985 patients. The review yielded 18 OS and 17 PFS prognosticators. These were classified as preoperative (radiologic; clinical), intraoperative, and postoperative (molecular; histopathologic; clinical) prognosticators. In addition, 21 resectability predictors were categorized as preoperative (radiologic; clinical), intraoperative (surgical approach and assistive technology), and postoperative (histopathologic; clinical). The quality assessment revealed 24/27 studies had low risk of bias. One study with moderate and two studies with high risk of bias were included. CONCLUSION Negative prognosticators reported in ≥2 studies included putaminal or paralimbic involvement and higher tumor grade, while seizures at presentation, isocitrate dehydrogenase (IDH) mutation, increased extent of resection, and higher Karnofsky Performance Status preoperatively and at 3 months postoperation were positive prognosticators. Resectability predictors reported in ≥2 studies included the positive predictors of zone I/zone IV tumor location and intraoperative imaging use and the negative predictor of encased lenticulostriate arteries. Paralimbic INGs are not a single entity with homogeneous prognosis. Integration of identified prognosticators in a prospective trial to devise a grading system for INGs can improve clinical decision-making.
Collapse
Affiliation(s)
- Ariadni Papadopoulou
- Division of Medicine, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
| | - Niraj S. Kumar
- Division of Medicine, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
19
|
Sun D, Schaft EV, van Stempvoort BM, Gebbink TA, van ‘t Klooster M, van Eijsden P, van der Salm SMA, Willem Dankbaar J, Zijlmans M, Robe PA. Intraoperative mapping of epileptogenic foci and tumor infiltration in neuro-oncology patients with epilepsy. Neurooncol Adv 2024; 6:vdae125. [PMID: 39156617 PMCID: PMC11327616 DOI: 10.1093/noajnl/vdae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
Background Epileptogenesis and glioma growth have a bidirectional relationship. We hypothesized people with gliomas can benefit from the removal of epileptic tissue and that tumor-related epileptic activity may signify tumor infiltration in peritumoral regions. We investigated whether intraoperative electrocorticography (ioECoG) could improve seizure outcomes in oncological glioma surgery, and vice versa, what epileptic activity (EA) tells about tumor infiltration. Methods We prospectively included patients who underwent (awake) ioECoG-assisted diffuse-glioma resection through the oncological trajectory. The IoECoG-tailoring strategy relied on ictal and interictal EA (spikes and sharp waves). Brain tissue, where EA was recorded, was assigned for histopathological examination separate from the rest of the tumor. Weibull regression was performed to assess how residual EA and extent of resection (EOR) related to the time-to-seizure recurrence, and we investigated which type of EA predicted tumor infiltration. Results Fifty-two patients were included. Residual spikes after resection were associated with seizure recurrence in patients with isocitrate dehydrogenase (IDH) mutant astrocytoma or oligodendroglioma (HR = 7.6[1.4-40.0], P-value = .01), independent from the EOR. This was not observed in IDH-wildtype tumors. All tissue samples resected based on interictal spikes were infiltrated by tumor, even if the MRI did not show abnormalities. Conclusions Complete resection of epileptogenic foci in ioECoG may promote seizure control in IDH-mutant gliomas. The cohort size of IDH-wildtype tumors was too limited to draw definitive conclusions. Interictal spikes may indicate tumor infiltration even when this area appears normal on MRI. Integrating electrophysiology guidance into oncological tumor surgery could contribute to improved seizure outcomes and precise guidance for radical tumor resection.
Collapse
Affiliation(s)
- Dongqing Sun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eline V Schaft
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bibi M van Stempvoort
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tineke A Gebbink
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maryse van ‘t Klooster
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra M A van der Salm
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Stichting Epilepsie Instellingen Nederland, The Netherlands
| | - Pierre A Robe
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
20
|
Youshani AS, Heal C, Lee JX, Younis M, Mohanraj R, Maye H, Bailey M, Coope D, D’Urso PI, Karabatsou K. Glioma-related epilepsy following low-grade glioma surgery. Neurooncol Adv 2024; 6:vdae127. [PMID: 39220245 PMCID: PMC11362847 DOI: 10.1093/noajnl/vdae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Background Epileptic seizures commonly burden low-grade glioma (LGG) patients and negatively impact quality of life, neurocognition, and general patient health. Anti-seizure medications (ASMs) are used to manage seizures but can result in undesired side effects. Our aim was to report our experience in epilepsy in one of the largest case series of LGG patients (reclassified in accordance with the WHO 2021 classification). Furthermore, we evaluate our postoperative seizure frequency difference between LGG patients who use preoperative ASMs and ones with no ASMs. Methods Data were retrospectively collected from Salford Royal Hospital electronic records and Neuro-Oncology database from 2006 to 2022. Descriptive statistics were performed for demographic analysis, while multivariable analysis was used to determine postoperative seizure-free outcomes. Results In total, 257 operations were performed on 206 patients. Postoperatively, 114 patients suffered from seizures, and approximately 45.2% of patients developed seizures at 3-12 months postsurgery, with the odds higher in patients on preoperative ASMs. There was no evidence to suggest a higher postoperative seizure rate in patients undergoing awake craniotomy versus general anesthetic. The extent of resection (EOR) was inversely related to seizure failure, with gross-total resection showing a statistically significant reduction in seizures in comparison to all other surgical resections. Conclusions In our experience, there is no evidence to suggest a reduced postoperative seizure outcome when prescribing preoperative ASMs. EOR is an independent prognosticator for postoperative seizure failure with all other variables demonstrating nonsignificance. Overall, a larger study can investigate the role of ASMs in LGG in greater detail.
Collapse
Affiliation(s)
- Amir Saam Youshani
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
- Division of Neurosciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Calvin Heal
- Division of Population Health, Health Services and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jing X Lee
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Michael Younis
- Manchester Medical School, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Rajiv Mohanraj
- Department of Neurology, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Helen Maye
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Matthew Bailey
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - David Coope
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
- Division of Neurosciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Pietro I D’Urso
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Konstantina Karabatsou
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| |
Collapse
|
21
|
Rudà R, Bruno F, Pellerino A. Epilepsy in gliomas: recent insights into risk factors and molecular pathways. Curr Opin Neurol 2023; 36:557-563. [PMID: 37865836 DOI: 10.1097/wco.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the molecular pathways governing the development of seizures in glioma patients. RECENT FINDINGS The intrinsic epileptogenicity of the neuronal component of glioneuronal and neuronal tumors is the most relevant factor for seizure development. The two major molecular alterations behind epileptogenicity are the rat sarcoma virus (RAS)/mitogen-activated protein kinase / extracellular signal-regulated kinase (MAPK/ERK) and phosphatidylinositol-3-kinase / protein kinase B / mammalian target of rapamycin (P13K/AKT/mTOR) pathways. The BRAFv600E mutation has been shown in experimental models to contribute to epileptogenicity, and its inhibition is effective in controlling both seizures and tumor growth. Regarding circumscribed astrocytic gliomas, either BRAFv600E mutation or mTOR hyperactivation represent targets of treatment. The mechanisms of epileptogenicity of diffuse lower-grade gliomas are different: in addition to enhanced glutamatergic mechanisms, the isocitrate dehydrogenase (IDH) 1/2 mutations and their product D2-hydroxyglutarate (D2HG), which is structurally similar to glutamate, exerts excitatory effects on neurons also dependent on the presence of astrocytes. In preclinical models IDH1/2 inhibitors seem to impact both tumor growth and seizures. Conversely, the molecular factors behind the epileptogenicity of glioblastoma are unknown. SUMMARY This review summarizes the current state of molecular knowledge on epileptogenicity in gliomas and highlights the relationships between epileptogenicity and tumor growth.
Collapse
Affiliation(s)
- Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | | | | |
Collapse
|
22
|
Joghataei MT, Bakhtiarzadeh F, Dehghan S, Ketabforoush AHME, Golab F, Zarbakhsh S, Ahmadirad N. The role of neurotransmitters in glioblastoma multiforme-associated seizures. Int J Dev Neurosci 2023; 83:677-690. [PMID: 37563091 DOI: 10.1002/jdn.10294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
GBM, or glioblastoma multiforme, is a brain tumor that poses a great threat to both children and adults, being the primary cause of death related to brain tumors. GBM is often associated with epilepsy, which can be debilitating. Seizures and the development of epilepsy are the primary symptoms that have a severe impact on the quality of life for GBM patients. It is increasingly apparent that the nervous system plays an essential role in the tumor microenvironment for all cancer types, including GBM. In recent years, there has been a growing understanding of how neurotransmitters control the progression of gliomas. Evidence suggests that neurotransmitters and neuromodulators found in the tumor microenvironment play crucial roles in the excitability, proliferation, quiescence, and differentiation of neurons, glial cells, and neural stem cells. The involvement of neurotransmitters appears to play a significant role in various stages of GBM. In this review, the focus is on presenting updated knowledge and emerging ideas regarding the interplay between neurotransmitters and neuromodulators, such as glutamate, GABA, norepinephrine, dopamine, serotonin, adenosine, and their relationship with GBM and the seizures induced by this condition. The review aims to explore the current understanding and provide new insights into the complex interactions between these neurotransmitters and neuromodulators in the context of GBM-related seizures.
Collapse
Affiliation(s)
| | - Fatemeh Bakhtiarzadeh
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Samaneh Dehghan
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fereshteh Golab
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sam Zarbakhsh
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Nooshin Ahmadirad
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
Chi X, Lu J, Guo Z, Wang J, Liu G, Jin Z, Wang Y, Zhang Q, Sun T, Ji N, Zhang Y. Susceptibility to preoperative seizures in glioma patients with elevated homocysteine levels. Epilepsia Open 2023; 8:1350-1361. [PMID: 37491869 PMCID: PMC10690701 DOI: 10.1002/epi4.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Seizures are a common clinical presentation in patients with glioma and substantially impact patients' quality of life. Hyperhomocysteinemia is defined as abnormally high serum levels of homocysteine (Hcy) and is reportedly linked to susceptibility to various nervous system diseases. However, it remains unclear whether and how hyperhomocysteinemia and its associated genetic polymorphisms promote seizures in glioma patients. METHODS We retrospectively reviewed all medical data from 127 patients with malignant gliomas, who underwent initial tumor resection by our team between July 2019 and June 2021 and had preoperative measurements of serum Hcy levels. According to whether they had at least one seizure before surgery, they were divided into the seizure and nonseizure groups. We also detected polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene and measured intratumoral Hcy levels in these patients. RESULTS Hyperhomocysteinemia was a susceptibility factor for preoperative seizures in glioma patients according to both univariate analyses (P < 0.001) and multivariate logistic regression analyses (OR 1.239, 95% CI 1.062-1.445, P = 0.007). Patients with the MTHFR C677T variant exhibited elevated serum Hcy levels (P = 0.027) and an increased prevalence of preoperative seizures (P = 0.019). Intratumoral Hcy levels were positively correlated with serum Hcy levels (R = 0.231, P = 0.046) and were elevated in patients with hyperhomocysteinemia (P = 0.031), the MTHFR C677T variant (P = 0.002) and preoperative seizures (P = 0.003). High intratumoral Hcy levels, rather than hyperhomocysteinemia or the MTHFR C677T variant, emerged as an independent risk factor for preoperative seizures (OR 1.303, 95% CI 1.015-1.673, P = 0.038). Furthermore, the effects of hyperhomocysteinemia on epileptic susceptibility were reduced to nonsignificance when intratumoral Hcy was controlled to the same level between groups. SIGNIFICANCE Glioma patients with hyperhomocysteinemia and the MTHFR C677T variant were susceptible to preoperative seizures, suggesting their potential as biomarkers for the management of seizures in glioma patients. The elevation of intratumoral Hcy is a possible mechanism underlying this susceptibility.
Collapse
Affiliation(s)
- Xiaohan Chi
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Jingjing Lu
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zhengguang Guo
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic MedicinePeking Union Medical CollegeBeijingChina
| | - Junmei Wang
- Department of NeuropathologyBeijing Neurosurgical InstituteBeijingChina
| | - Gaifen Liu
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zeping Jin
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yi Wang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Qianhe Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Tai Sun
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yang Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| |
Collapse
|
24
|
Wang L, Zhang J, Wang J, Xue H, Deng L, Che F, Heng X, Zheng X, Lu Z, Yang L, Tan Q, Xu Y, Zhang Y, Ji X, Li G, Yang F, Xue F. Postoperative prognostic nomogram for adult grade II/III astrocytoma in the Chinese Han population. Health Inf Sci Syst 2023; 11:23. [PMID: 37151917 PMCID: PMC10160268 DOI: 10.1007/s13755-023-00223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Background Prognostic models of glioma have been the focus of many studies. However, most of them are based on Western populations. Additionally, because of the complexity of healthcare data in China, it is important to select a suitable model based on existing clinical data. This study aimed to develop and independently validate a nomogram for predicting the overall survival (OS) with newly diagnosed grade II/III astrocytoma after surgery. Methods Data of 472 patients with astrocytoma (grades II-III) were collected from Qilu Hospital as training cohort while data of 250 participants from Linyi People's Hospital were collected as validation cohort. Cox proportional hazards model was used to construct the nomogram and individually predicted 1-, 3-, and 5-year survival probabilities. Calibration ability, and discrimination ability were analyzed in both training and validation cohort. Results Overall survival was negatively associated with histopathology, age, subtotal resection, multiple tumors, lower KPS and midline tumors. Internal validation and external validation showed good discrimination (The C-index for 1-, 3-, and 5-year survival were 0.791, 0.748, 0.733 in internal validation and 0.754, 0.735, 0.730 in external validation, respectively). The calibration curves showed good agreement between the predicted and actual 1-, 3-, and 5-year OS rates. Conclusion This is the first nomogram study that integrates common clinicopathological factors to provide an individual probabilistic prognosis prediction for Chinese Han patients with astrocytoma (grades II-III). This model can serve as an easy-to-use tool to advise patients and establish optimized surveillance approaches after surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s13755-023-00223-0.
Collapse
Affiliation(s)
- Lijie Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province China
- Institute for Medical Dataology, Shandong University, Jinan, China
| | - Jinling Zhang
- Cancer Center & the Research Center of Function Image on Brain Tumor, Linyi People’s Hospital, Shandong University, Linyi, China
| | - Jingtao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province China
- Institute for Medical Dataology, Shandong University, Jinan, China
| | - Hao Xue
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Shandong Provincial Key Laboratory of Brain Function Remodeling, Shandong University, Jinan, China
| | - Lin Deng
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Shandong Provincial Key Laboratory of Brain Function Remodeling, Shandong University, Jinan, China
| | - Fengyuan Che
- Neurology Department & the Research Center of Function Image on Brain Tumor, Linyi People’s Hospital, Shandong University, Linyi, China
| | - Xueyuan Heng
- Neurosurgery Department & the Research Center of Function Image on Brain Tumor, Linyi People’s Hospital, Shandong University, Linyi, China
| | - Xuejun Zheng
- Department of Radiology, Linyi People’s Hospital, Shandong University, Linyi, China
| | - Zilong Lu
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Liuqing Yang
- The Department for Chronic and Non-Communicable Disease and Endemic Disease Control and Prevention, Linyi Center for Disease Control and Prevention, Linyi, China
| | - Qihua Tan
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yeping Xu
- Synthesis Electronic Technology Co., Ltd., Jinan, China
| | - Yanchun Zhang
- Institute for Sustainable Industries & Liveable Cities, College of Engineering and Science, Victoria University, Melbourne, VIC Australia
| | - Xiaokang Ji
- Institute for Medical Dataology, Shandong University, Jinan, China
| | - Gang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Shandong Provincial Key Laboratory of Brain Function Remodeling, Shandong University, Jinan, China
| | - Fan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province China
- Institute for Medical Dataology, Shandong University, Jinan, China
| | - Fuzhong Xue
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province China
- Institute for Medical Dataology, Shandong University, Jinan, China
| |
Collapse
|
25
|
Kumaria A, Ashkan K. Novel therapeutic strategies in glioma targeting glutamatergic neurotransmission. Brain Res 2023; 1818:148515. [PMID: 37543066 DOI: 10.1016/j.brainres.2023.148515] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/11/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
High grade gliomas carry a poor prognosis despite aggressive surgical and adjuvant approaches including chemoradiotherapy. Recent studies have demonstrated a mitogenic association between neuronal electrical activity and glioma growth involving the PI3K-mTOR pathway. As the predominant excitatory neurotransmitter of the brain, glutamate signalling in particular has been shown to promote glioma invasion and growth. The concept of the neurogliomal synapse has been established whereby glutamatergic receptors on glioma cells have been shown to promote tumour propagation. Targeting glutamatergic signalling is therefore a potential treatment option in glioma. Antiepileptic medications decrease excess neuronal electrical activity and some may possess anti-glutamate effects. Although antiepileptic medications continue to be investigated for an anti-glioma effect, good quality randomised trial evidence is lacking. Other pharmacological strategies that downregulate glutamatergic signalling include riluzole, memantine and anaesthetic agents. Neuromodulatory interventions possessing potential anti-glutamate activity include deep brain stimulation and vagus nerve stimulation - this contributes to the anti-seizure efficacy of the latter and the possible neuroprotective effect of the former. A possible role of neuromodulation as a novel anti-glioma modality has previously been proposed and that hypothesis is extended to include these modalities. Similarly, the significant survival benefit in glioblastoma attributable to alternating electrical fields (Tumour Treating Fields) may be a result of disruption to neurogliomal signalling. Further studies exploring excitatory neurotransmission and glutamatergic signalling and their role in glioma origin, growth and propagation are therefore warranted.
Collapse
Affiliation(s)
- Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK.
| | | |
Collapse
|
26
|
Zhang J, Gong L, Zhu H, Sun W, Tian J, Zhang Y, Liu Q, Li X, Zhang F, Wang S, Zhu S, Ding D, Zhang W, Yang C. RICH2 decreases the mitochondrial number and affects mitochondrial localization in diffuse low-grade glioma-related epilepsy. Neurobiol Dis 2023; 188:106344. [PMID: 37926169 DOI: 10.1016/j.nbd.2023.106344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023] Open
Abstract
Epilepsy, a common complication of diffuse low-grade gliomas (DLGGs; diffuse oligodendroglioma and astrocytoma collectively), severely compromises the quality of life of patients. DLGG epileptogenicity may primarily be generated by interactions between the tumor and the neocortex. Neuronal uptake of dysfunctional mitochondria from the extracellular environment can lead to abnormal neuronal discharge. Mitochondrial dysfunction is frequently observed in gliomas that can transmigrate across the plasma membranes. Here, we examined the role of the Rho GTPase-activating protein 44 (RICH2) in mitochondrial dynamics and DLGG-related epilepsy. We investigated the association between mitochondrial and RICH2 expression in human DLGG tissues using immunohistochemistry. We examined the association between RICH2 and epilepsy in nude mouse glioma models by electrophysiology. The effect of RICH2 on mitochondrial morphology and calcium motility were assessed by single cell fluorescence microscopy. Quantitative RT-PCR (qRT-PCR) and Western blot analysis were performed to characterize RICH2 induced expression changes in the genes related to mitochondrial dynamics, mitogenesis and mitochondrial function. We found that RICH2 expression was higher in oligodendroglioma than in astrocytoma and was correlated with better prognosis and higher epilepsy rate in patients. The expression of mitochondria may be associated with clinical DLGG-related epilepsy and reduced by RICH2 overexpression. And RICH2 could promote DLGG-related epilepsy in tumorigenic nude mice. RICH2 overexpression decreased calcium flow and the mitochondria released from glioma cells (SW1088 and U251) into the extracellular environment, potentially via downregulation of MFN-1/MFN-2 levels which suggests reduced mitochondrial fusion. In addition, we observed decreased mitochondrial trafficking into neurons (released from glioma cells and trafficked into neurons), which could explain the higher incidence of DLGG-related epilepsy due to reduced neuroprotection. Furthermore, RICH2 downregulated MAPK/ERK/HIF-1 pathway. In conclusion, these results suggest that RICH2 could promote epilepsy by (i) inhibiting mitochondrial fusion via MFN downregulation and Drp-1 upregulation; (ii) altering the MAPK/ERK/Hif-1 signaling axis. RICH2 may be a potential target in the treatment of DLGG-related epilepsy.
Collapse
Affiliation(s)
- Jiarui Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China; Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Li Gong
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Huayu Zhu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Sun
- Institute for Biomedical Sciences of Pain, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Tian
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yan Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Qiao Liu
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaolan Li
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Fuqin Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shumei Wang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shaojun Zhu
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Dongjing Ding
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Zhang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| | - Chen Yang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| |
Collapse
|
27
|
Shi Y, Liu C, Cheng D, Tang L, Qi Z. Effects of gross total resection and subtotal resection on survival outcomes of glioma patients: a meta-analysis. Biotechnol Genet Eng Rev 2023; 39:1321-1344. [PMID: 36772792 DOI: 10.1080/02648725.2023.2177034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
This study was to conduct a meta-analysis to explore the impact of gross total resection (GTR) and subtotal resection (STR) on survival outcomes in glioma patients. Relevant studies were searched in multiple databases from the available date of inception through 30 December 2021. The weighted mean differences (WMDs), relative risks (RRs), or hazard ratios (HRs) with 95% confidence intervals (CIs) were used to access the effect of GTR versus STR treatments on the outcomes. The histology (low-grade or high-grade) and study population (children and adults) were used for subgroup analysis. Sensitivity analysis was performed for all outcomes. Begg's test and trim-and-fill method were used for publication bias. Totally 100 studies enrolling 62,129 patients were selected in this meta-analysis. The summary results showed that GTR was superior in improving 1-, 2-, 3-, 5-, 10-, 15-year overall survival (OS), OS time, 1-, 3-, 5-year progression-free survival (PFS), recurrence, local control and seizure control among glioma patients. In addition, high-grade patients who underwent GTR had improvements in 1-, 2- and 3-year OS, OS time, and 1-year PFS, while low-grade patients receiving GTR had improvements in 2-, 5- and 15-year OS, recurrence, seizure control, and tumor progression compared with those receiving STR. GTR was likely to be more effective on survival outcomes than STR among patients with gliomas.
Collapse
Affiliation(s)
- Yu Shi
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Chengming Liu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Dejing Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Liyan Tang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Zhenyu Qi
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| |
Collapse
|
28
|
Amjad G, Zeinali Zadeh M, Azmoudeh-Ardalan F, Jalali AH, Shakiba M, Ghavami N, Oghabian Z, Oghabian MA, Firouznia S, Rafiei B, Sabet Rasekh P, Tahmasebi Arashloo F, Firouznia K. Evaluation of multimodal MR imaging for differentiating infiltrative versus reactive edema in brain gliomas. Br J Neurosurg 2023; 37:1031-1039. [PMID: 33263433 DOI: 10.1080/02688697.2020.1849541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/05/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the border of glial tumors by diffusion weighted imaging (DWI), apparent diffusion co-efficient (ADC), magnetic resonance spectroscopy (MRS) and perfusion brain MRI. PATIENTS AND METHODS Ten patients with brain gliomas were enrolled [mean age: 35.3 ± 13.2, range: 20-62]. Conventional MRI was performed for all patients. Besides, tumor mapping based on Choline (Cho)/Creatine (Cr) color map in MRS, perfusion and diffusion color maps, were gathered. Different tumoral and peritumoral regions [normal tissue, reactive edema, infiltrative edema, and tumor core] were defined. MRI criteria were evaluated in areas targeted for biopsy and histopathologic evaluation was determined. RESULTS Tumor cell positive samples [one necrosis, 26 infiltrative and nine tumor cores] composed 36 (75%) of the 48 samples. Seven (19.4%) of the positive samples were interpreted as not tumor on MRI. Five were identified as reactive edema and two as normal tissue] [kappa: .67, p-value < .001]. Mean of ADC, median of N-acetylaspartate (NAA) and NAA/Cho were statistically different between positive and negative samples (p = .02 and p < .001, respectively). Mean ADC and median Cho/NAA were statistically different in missed tumor containing tissue presented as reactive edema compared to normal and correctly diagnosed reactive edema samples together (p-values < .05). CONCLUSIONS Multimodal MRI could define infiltrated borders of brain gliomas.
Collapse
Affiliation(s)
- Ghazaleh Amjad
- Shahid Akbar Abadi Clinical Research Development Unit (ShCRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mehdi Zeinali Zadeh
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Azmoudeh-Ardalan
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Ghavami
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeynab Oghabian
- Neuroimaging and Analysis Group Research Center, Molecular and Cellular Imaging Department, Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Oghabian
- Neuroimaging and Analysis Group Research Center, Molecular and Cellular Imaging Department, Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Firouznia
- Department of Engineering Mathematics, University of Bristol, Bristol, UK
| | - Behrouz Rafiei
- Medical Physics, Tehran University of Medical Sciences, Tehran, Iran
| | - Parto Sabet Rasekh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
29
|
Wu S, Wang C, Li N, Ballah AK, Lyu J, Liu S, Wang X. Analysis of Prognostic Factors and Surgical Management of Elderly Patients with Low-Grade Gliomas. World Neurosurg 2023; 176:e20-e31. [PMID: 36858293 DOI: 10.1016/j.wneu.2023.02.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The number of elderly patients with low-grade glioma (LGG) is increasing, but their prognostic factors and surgical treatment are still controversial. This paper aims to investigate the prognostic factors of overall survival and cancer-specific survival in elderly patients with LGG and analyze the optimal surgical treatment strategy. METHODS Patients in the study were obtained from the Surveillance, Epidemiology, and End Results database and patients were randomized into a training and a test set (7:3). Clinical variables were analyzed by univariate and multivariate Cox regression analysis to screen for significant prognostic factors, and nomograms visualized the prognosis. In addition, survival analysis of elderly patients regarding different surgical management was also analyzed by Kaplan-Meier curves. RESULTS Six prognostic factors were screened by univariate and multivariate Cox regression analysis on the training set: tumor site, laterality, histological type, the extent of surgery, radiotherapy, and chemotherapy, and all factors were visualized by nomogram. And we evaluated the accuracy of the nomogram model using consistency index, calibration plots, receiver operator characteristic curves, and decision curve analysis, showing that the nomogram has strong accuracy and applicability. We also found that gross total resection improved overall survival and cancer-specific survival in patients with LGG aged ≥65 years relative to those who did not undergo surgery (P < 0.001). CONCLUSIONS Based on the Surveillance, Epidemiology, and End Results database, we created and validated prognostic nomograms for elderly patients with LGG, which can help clinicians to provide personalized treatment services and clinical decisions for their patients. More importantly, we found that older age alone should not preclude aggressive surgery for LGGs.
Collapse
Affiliation(s)
- Shuaishuai Wu
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Changli Wang
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ning Li
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Augustine K Ballah
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jun Lyu
- Clinical Research Department, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Shengming Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
| | - Xiangyu Wang
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| |
Collapse
|
30
|
Ng S, Duffau H. Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies. Cancers (Basel) 2023; 15:3698. [PMID: 37509359 PMCID: PMC10378506 DOI: 10.3390/cancers15143698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The ability of neural circuits to compensate for damage to the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between the brain and the tumor activates modulations of plasticity, as well as tumor proliferation and migration, by means of paracrine and electrical intercommunications. Such adaptative mechanisms have a major impact on the benefits and risks of oncological treatments but are still disregarded by current neuro-oncological guidelines. In this review, the authors first aimed to highlight clinical, radiological, and oncological markers that robustly reflect the plasticity potentials and limitations in LGG patients, including the location of the tumor and the degree of critical white matter tract infiltration, the velocity of tumor expansion, and the reactional changes of neuropsychological performances over time. Second, the interactions between the potential/limitations of cerebral plasticity and the efficacy/tolerance of treatment options (i.e., surgery, chemotherapy, and radiotherapy) are reviewed. Finally, a longitudinal and multimodal treatment approach accounting for the evolutive profiles of brain plasticity is proposed. Such an approach integrates personalized predictive models of plasticity potentials with a step-by-step therapeutic decision making and supports onco-functional balanced strategies in patients with LGG, with the ultimate aim of optimizing overall survival and quality of life.
Collapse
Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de le Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale 1191, 34094 Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de le Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale 1191, 34094 Montpellier, France
| |
Collapse
|
31
|
Le VT, Nguyen AM, Pham TA, Nguyen PL. Tumor-related epilepsy and post-surgical outcomes: tertiary hospital experience in Vietnam. Sci Rep 2023; 13:10859. [PMID: 37407622 DOI: 10.1038/s41598-023-38049-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023] Open
Abstract
Seizures have a significant impact on the quality of life of those who suffer. This study aimed to evaluate the variables that influence the incidence of seizures during the perioperative period and effective measures to enhance epilepsy outcomes among individuals undergoing surgical resection of brain tumors. The authors carried out a prospective observational analysis of all patients who experienced seizures before their brain tumor surgery at UMC, HCMC between 2020 and 2022. 54 cases presented with seizures were enrolled for the study, generalized seizure was the most prevalent seizure type (61.1%), followed by focal seizure (29.6%). The majority of patients presented with seizures are those who were diagnosed with glioma. Low-grade gliomas and frontotemporal lobe tumors increase the postoperative risk of seizure. Other predictive factors are a prolonged history of seizure, especially resistant epilepsy and major peritumoral edema. In contrast, gross total resection reduces postoperative seizure incidence. There was correlation between Ki67 proliferation index and seizure incidence in both low-grade and high-grade gliomas. ECoG made insubstantial difference in enhancing the epilepsy surgery outcome. Overall, 88.9% of patients were seizure-free at 6 months of follow-up (Engel Class I), 7.4% were almost seizure-free (Class II), and 3.7% had significant improvement (Class III), figures for 12-month follow-up were 87.0%, 9.3%, and 3.7% respectively. A shorter history of seizure and gross-total resection appear to be associated with a favorable prognosis for seizure control.
Collapse
Affiliation(s)
- Viet-Thang Le
- Faculty of Medicine, University of Medicine and Pharmacy, 217 Hong Bang Street, 11th Ward, 5th District, Ho Chi Minh City, 700000, Vietnam
- Department of Neurosurgery, University Medical Center, UMC, 215 Hong Bang Street, 11th Ward, 5th District, Ho Chi Minh City, 700000, Vietnam
| | - Anh Minh Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, 217 Hong Bang Street, 11th Ward, 5th District, Ho Chi Minh City, 700000, Vietnam
- Department of Neurosurgery, University Medical Center, UMC, 215 Hong Bang Street, 11th Ward, 5th District, Ho Chi Minh City, 700000, Vietnam
| | - Tuan Anh Pham
- Faculty of Medicine, University of Medicine and Pharmacy, 217 Hong Bang Street, 11th Ward, 5th District, Ho Chi Minh City, 700000, Vietnam
- Department of Neurosurgery, Nguyen Tri Phuong Hospital, 468 Nguyen Trai Street, 8th Ward, 5th District, Ho Chi Minh City, 700000, Vietnam
| | - Phuc Long Nguyen
- Department of Neurosurgery, University Medical Center, UMC, 215 Hong Bang Street, 11th Ward, 5th District, Ho Chi Minh City, 700000, Vietnam.
| |
Collapse
|
32
|
Picca A, Bruno F, Nichelli L, Sanson M, Rudà R. Advances in molecular and imaging biomarkers in lower-grade gliomas. Expert Rev Neurother 2023; 23:1217-1231. [PMID: 37982735 DOI: 10.1080/14737175.2023.2285472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Lower-grade (grade 2-3) gliomas (LGGs) constitutes a group of primary brain tumors with variable clinical behaviors and treatment responses. Recent advancements in molecular biology have redefined their classification, and novel imaging modalities emerged for the noninvasive diagnosis and follow-up. AREAS COVERED This review comprehensively analyses the current knowledge on molecular and imaging biomarkers in LGGs. Key molecular alterations, such as IDH mutations and 1p/19q codeletion, are discussed for their prognostic and predictive implications in guiding treatment decisions. Moreover, the authors explore theranostic biomarkers for the potential of tailored therapies. Additionally, they also describe the utility of advanced imaging modalities, including widely available techniques, as dynamic susceptibility contrast perfusion-weighted imaging and less validated, emerging approaches, for the noninvasive LGGs characterization and follow-up. EXPERT OPINION The integration of molecular markers enhanced the stratification of LGGs, leading to the new concept of integrated histomolecular classification. While the IDH mutation is an established key prognostic and predictive marker, recent results from IDH inhibitors trials showed its potential value as a theranostic marker. In this setting, advanced MRI techniques such as 2-D-hydroxyglutarate spectroscopy are very promising for the noninvasive diagnosis and monitoring of LGGs. This progress offers exciting prospects for personalized medicine and improved treatment outcomes in LGGs.
Collapse
Affiliation(s)
- Alberto Picca
- Service de Neurologie 2 Mazarin, Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
- Sorbonne Université, Inserm, CNRS, UMRS1127, Institut du Cerveau-Paris Brain Institute-ICM, AP-HP, Paris, France
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science University Hospital, Turin, Italy
| | - Lucia Nichelli
- Service de Neuroradiologie, Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - Marc Sanson
- Service de Neurologie 2 Mazarin, Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
- Sorbonne Université, Inserm, CNRS, UMRS1127, Institut du Cerveau-Paris Brain Institute-ICM, AP-HP, Paris, France
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science University Hospital, Turin, Italy
| |
Collapse
|
33
|
Fauvet C, Villain M, Gatignol P. Repeated awake surgery and quality of life in patients with diffuse glioma: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:156. [PMID: 37382692 DOI: 10.1007/s10143-023-02073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/12/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
Diffuse gliomas significantly affect patients' daily lives. Because of the high risk of recurrence and anaplasic transformation, repeated surgery can be proposed in awake condition to prolongs overall survival by limiting and reducing residual tumour volume. However, oncological interest alone is no longer sufficient due to the consequent increase in median survival, and quality of life is becoming an important issue in clinical decision-making. This systematic review focuses on the effects of repeated surgery in awake condition on the quality of life of adults with diffuse glioma through three parameters: return to work, presence of postoperative neurocognitive disorders, and occurrence of epileptic seizures. A systematic review of the last 20 years was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards. Summarized data from selected studies were processed quantitatively, using a meta-analysis process, with the Review Manager 5.4 software. Five databases (PubMed, Web of Science, Science Direct, Dimensions, and Embase) were used. Fifteen articles were selected for qualitative analysis and 11 for meta-analysis. One hundred and fifty-one patients (85%) returned to an active socio-professional life after repeated surgery, and 78 (41%) presented neurocognitive disorders in the immediate postoperative period, only 3% (n = 4) of them suffering from permanent disorders. One hundred and forty-nine (78%) participants were free of epileptic seizure after repeated surgery. This systematic review of the literature highlights the benefit of repeated surgery on the quality of life of patients with adult diffuse glioma.
Collapse
Affiliation(s)
| | - Marie Villain
- AP-HP, Service MPR, Pitié-Salpêtrière University Hospital, Paris, France.
- Speech Therapy Department, Sorbonne Université, Paris, France.
- Sorbonne Université, GRC No. 24, Handicap Moteur Et Cognitif & Réadaptation (HaMCRe) AP-HP, Sorbonne Université, 75013, Paris, France.
| | - Peggy Gatignol
- AP-HP, Service MPR, Pitié-Salpêtrière University Hospital, Paris, France
- Speech Therapy Department, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France
| |
Collapse
|
34
|
Drumm MR, Wang W, Sears TK, Bell-Burdett K, Javier R, Cotton KY, Webb B, Byrne K, Unruh D, Thirunavu V, Walshon J, Steffens A, McCortney K, Lukas RV, Phillips JJ, Mohamed E, Finan JD, Santana-Santos L, Heimberger AB, Franz CK, Kurz J, Templer JW, Swanson GT, Horbinski C. Postoperative risk of IDH-mutant glioma-associated seizures and their potential management with IDH-mutant inhibitors. J Clin Invest 2023; 133:e168035. [PMID: 37104042 PMCID: PMC10266777 DOI: 10.1172/jci168035] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/25/2023] [Indexed: 04/28/2023] Open
Abstract
Seizures are a frequent complication of adult-type diffuse gliomas, and are often difficult to control with medications. Gliomas with mutations in isocitrate dehydrogenase 1 or 2 (IDHmut) are more likely than IDH-wild type (IDHwt) gliomas to cause seizures as part of their initial clinical presentation. However, whether IDHmut is also associated with seizures during the remaining disease course, and whether IDHmut inhibitors can reduce seizure risk, are unclear. Clinical multivariable analyses showed that preoperative seizures, glioma location, extent of resection, and glioma molecular subtype (including IDHmut status) all contributed to postoperative seizure risk in adult-type diffuse glioma patients, and that postoperative seizures were often associated with tumor recurrence. Experimentally, the metabolic product of IDHmut, d-2-hydroxyglutarate, rapidly synchronized neuronal spike firing in a seizure-like manner, but only when non-neoplastic glial cells were present. In vitro and in vivo models recapitulated IDHmut glioma-associated seizures, and IDHmut inhibitors currently being evaluated in glioma clinical trials inhibited seizures in those models, independent of their effects on glioma growth. These data show that postoperative seizure risk in adult-type diffuse gliomas varies in large part by molecular subtype, and that IDHmut inhibitors could play a key role in mitigating such risk in IDHmut glioma patients.
Collapse
Affiliation(s)
| | | | | | - Kirsten Bell-Burdett
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rodrigo Javier
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | - Brynna Webb
- Department of Pharmacology, Northwestern University, Chicago, Illinois, USA
| | - Kayla Byrne
- Northwestern University, Evanston, Illinois, USA
| | | | | | | | | | | | - Rimas V. Lukas
- Ken & Ruth Davee Department of Neurology and
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Joanna J. Phillips
- Department of Neurological Surgery, Brain Tumor Center, UCSF, San Francisco, California, USA
| | - Esraa Mohamed
- Department of Neurological Surgery, Brain Tumor Center, UCSF, San Francisco, California, USA
| | - John D. Finan
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Amy B. Heimberger
- Department of Neurological Surgery and
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Colin K. Franz
- Ken & Ruth Davee Department of Neurology and
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Jessica W. Templer
- Ken & Ruth Davee Department of Neurology and
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | | | - Craig Horbinski
- Department of Neurological Surgery and
- Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
- Department of Pathology and
| |
Collapse
|
35
|
Kumar K, Dubey V, Zaidi SS, Tripathi M, Siraj F, Sharma MC, Chandra PS, Doddamani R, Dixit AB, Banerjee J. RNA Sequencing of Intraoperative Peritumoral Tissues Reveals Potential Pathways Involved in Glioma-Related Seizures. J Mol Neurosci 2023; 73:437-447. [PMID: 37268865 DOI: 10.1007/s12031-023-02125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
Tumor-induced changes in the peritumoral neocortex play a crucial role in generation of seizures. This study aimed to investigate the molecular mechanisms potentially involved in peritumoral epilepsy in low-grade gliomas (LGGs). Intraoperative peritumoral brain tissues resected from LGG patients with seizures (pGRS) or without seizures (pGNS) were used for RNA sequencing (RNA-seq). Comparative transcriptomics was performed to identify differentially expressed genes (DEGs) in pGRS compared to pGNS using deseq2 and edgeR packages (R). Gene set enrichment analysis (GSEA) using Gene Ontology terms and Kyoto Encyclopedia of Genes & Genomes (KEGG) pathways was performed using the clusterProfiler package (R). The expression of key genes was validated at the transcript and protein levels in the peritumoral region using real-time PCR and immunohistochemistry, respectively. A total of 1073 DEGs were identified in pGRS compared to pGNS, of which 559 genes were upregulated and 514 genes were downregulated (log2 fold-change ≥ 2, padj < 0.001). The DEGs in pGRS were highly enriched in the "Glutamatergic Synapse" and "Spliceosome" pathways, with increased expression of GRIN2A (NR2A), GRIN2B (NR2B), GRIA1 (GLUR1), GRIA3 (GLUR3), GRM5, CACNA1C, CACNA1A, and ITPR2. Moreover, increased immunoreactivity was observed for NR2A, NR2B, and GLUR1 proteins in the peritumoral tissues of GRS. These findings suggest that altered glutamatergic signaling and perturbed Ca2+ homeostasis may be potential causes of peritumoral epilepsy in gliomas. This explorative study identifies important genes/pathways that merit further characterization for their potential involvement in glioma-related seizures.
Collapse
Affiliation(s)
| | - Vivek Dubey
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Syeda S Zaidi
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | | | - Fouzia Siraj
- ICMR-National Institute of Pathology, New Delhi, India
| | | | | | | | - Aparna Banerjee Dixit
- Dr. B.R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India.
| | - Jyotirmoy Banerjee
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
| |
Collapse
|
36
|
Duffau H. Oncological and functional neurosurgery: Perspectives for the decade regarding diffuse gliomas. Rev Neurol (Paris) 2023; 179:437-448. [PMID: 36907710 DOI: 10.1016/j.neurol.2023.01.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 03/12/2023]
Abstract
For decades, diffuse glioma (DG) studies mostly focused on oncological considerations, whereas functional outcomes received less attention. Currently, because overall survival has increased in DG, especially in low-grade glioma (overall survival > 15 years), quality of life including neurocognitive and behavioral aspects should be assessed and preserved more systematically, particularly regarding surgery. Indeed, early maximal tumor removal results in greater survival in both high-grade and low-grade gliomas, leading to propose "supra-marginal" resection, with excision of the peritumoral zone in diffuse neoplasms. To minimize functional risks while maximizing the extent of resection, traditional "tumor-mass resection" is replaced by "connectome-guided resection" conducted under awake mapping, taking into account inter-individual brain anatomo-functional variability. A better understanding of the dynamic interplay between DG progression and reactional neuroplastic mechanisms is critical to adapt a personalized multistage therapeutic strategy, with integration of functional neurooncological (re)operation(s) in a multimodal management scheme including repeated medical therapies. Because the therapeutic armamentarium remains limited, the aims of this paradigmatic shift are to predict one/several step(s) ahead glioma behavior, its modifications, and compensatory neural networks reconfiguration over time in order to optimize the onco-functional benefit of each treatment - either in isolation or in combination with others - in human beings bearing a chronic tumoral disease while enjoying an active familial and socio-professional life as close as possible to their expectations. Thus, new ecological endpoints such as return to work should be incorporated into future DG trials. "Preventive neurooncology" might also be envisioned, by proposing a screening policy to discover and treat incidental glioma earlier.
Collapse
Affiliation(s)
- H Duffau
- Department of Neurosurgery, Montpellier University Medical Center, Gui-de-Chauliac Hospital, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", National Institute for Health and Medical Research (Inserm), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, 34091 Montpellier, France.
| |
Collapse
|
37
|
Merenzon MA, Bhatia S, Levy A, Eatz T, Morell AA, Daggubati LC, Luther E, Shah AH, Komotar RJ, Ivan ME. Frontal lobe low-grade tumors seizure outcome: a pooled analysis of clinical predictors. Clin Neurol Neurosurg 2023; 226:107600. [PMID: 36709666 DOI: 10.1016/j.clineuro.2023.107600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Seizures present in 50-90 % of cases with low-grade brain tumors. Frontal lobe epilepsy is associated with dismal seizure outcomes compared to temporal lobe epilepsy. Our objective is to conduct a systematic review, report our case series, and perform a pooled analysis of clinical predictors of seizure outcomes in frontal lobe low-grade brain tumors. METHODS Searches of five electronic databases from January 1990 to June 2022 were reviewed following PRISMA guidelines. Individual patient data was extracted from 22 articles that fit the inclusion criteria. A single-surgeon case series from our institution was also retrospectively reviewed and analyzed through a pooled cohort of 127 surgically treated patients with frontal lobe low-grade brain tumors. RESULTS The mean age at surgery was 30.8 years, with 50.4 % of patients diagnosed as oligodendrogliomas. The majority of patients (81.1 %) were seizure-free after surgery (Engel I). On the multivariate analysis, gross total resection (GTR) (OR = 8.77, 95 % CI: 1.99-47.91, p = 0.006) and awake resection (OR = 9.94, 95 % CI: 1.93-87.81, p = 0.015) were associated with seizure-free outcome. A Kaplan-Meier curve showed that the probability of seizure freedom fell to 92.6 % at 3 months, and to 85.5 % at 27.3 months after surgery. CONCLUSION Epilepsy from tumor origin demands a balance between oncological management and epilepsy cure. Our pooled analysis suggests that GTR and awake resections are positive predictive factors for an Engel I at more than 6 months follow-up. To validate these findings, a longer-term follow-up and larger cohorts are needed.
Collapse
Affiliation(s)
- Martín A Merenzon
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Shovan Bhatia
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adam Levy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tiffany Eatz
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexis A Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lekhaj C Daggubati
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
38
|
Zhang H, Ma XJ, Xiang XP, Wang QY, Tang JL, Yu XY, Xu JH. Clinical, Morphological, and Molecular Study on Grade 2 and 3 Pleomorphic Xanthoastrocytoma. Curr Oncol 2023; 30:2405-2416. [PMID: 36826144 PMCID: PMC9955822 DOI: 10.3390/curroncol30020183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
PURPOSE Pleomorphic xanthoastrocytoma (PXA) is an uncommon astrocytoma that tends to occur in children and young adults and has a relatively favorable prognosis. The 2021 WHO classification of tumors of the central nervous system (CNS WHO), 5th edition, rates PXAs as grade 2 and grade 3. The histological grading was based on mitotic activity (≥2.5 mitoses/mm2). This study specifically evaluates the clinical, morphological, and, especially, the molecular characteristics of grade 2 and 3 PXAs. METHODS Between 2003 and 2021, we characterized 53 tumors with histologically defined grade 2 PXA (n = 36, 68%) and grade 3 PXA (n = 17, 32%). RESULTS Compared with grade 2 PXA, grade 3 PXA has a deeper location and no superiority in the temporal lobe and is more likely to be accompanied by peritumoral edema. In histomorphology, epithelioid cells and necrosis were more likely to occur in grade 3 PXA. Molecular analysis found that the TERT promoter mutation was more prevalent in grade 3 PXA than in grade 2 PXA (35% vs. 3%; p = 0.0005) and all mutation sites were C228T. The cases without BRAF V600E mutation or with necrosis in grade 3 PXA had a poor prognosis (p = 0.01). CONCLUSION These data define PXA as a heterogeneous astrocytoma. Grade 2 and grade 3 PXAs have different clinical and histological characteristics as well as distinct molecular profiles. TERT promoter mutations may be a significant genetic event associated with anaplastic progression. Necrosis and BRAF V600E mutation play an important role in the prognosis of grade 3 PXA.
Collapse
Affiliation(s)
- Hui Zhang
- Departments of Clinical Pathology, The Second Affiliated Hospital of Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou 310003, China
| | - Xiao-Jing Ma
- Departments of Clinical Pathology, The Second Affiliated Hospital of Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou 310003, China
| | - Xue-Ping Xiang
- Departments of Clinical Pathology, The Second Affiliated Hospital of Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou 310003, China
| | - Qi-Yuan Wang
- Departments of Clinical Radiography, The Second Affiliated Hospital of Medical College of Zhejiang University, Hangzhou 310003, China
| | - Jin-Long Tang
- Departments of Clinical Pathology, The Second Affiliated Hospital of Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou 310003, China
| | - Xiao-Yan Yu
- Departments of Clinical Pathology, The Second Affiliated Hospital of Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou 310003, China
| | - Jing-Hong Xu
- Departments of Clinical Pathology, The Second Affiliated Hospital of Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou 310003, China
| |
Collapse
|
39
|
Fang S, Li L, Weng S, Guo Y, Fan X, Jiang T, Wang Y. Altering patterns of sensorimotor network in patients with different pathological diagnoses and glioma-related epilepsy under the latest glioma classification of the central nervous system. CNS Neurosci Ther 2023; 29:1368-1378. [PMID: 36740245 PMCID: PMC10068458 DOI: 10.1111/cns.14109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/16/2022] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
AIMS We aimed to clarify the relationship between alterations in functional networks and glioma-related epilepsy (GRE) in patients with different molecular diagnoses. METHODS We enrolled 160 patients with prefrontal gliomas and different histories of GRE. The patients were grouped based on the latest pathological glioma classification and GRE history. Graph theory analysis was applied to reveal alterations in the sensorimotor networks among various subgroups. Binary logistic regression was used to identify risk factors for preoperative GRE onset. RESULTS Decreasing shortest path length was found in patients with GRE, regardless of the chromosome 1p/19q status. Nodes located in the premotor and supplementary motor areas showed decreased nodal betweenness centrality and vulnerability in patients with GRE and chromosome 1p/19q intact. Additionally, the node on the primary motor area showed decreased nodal vulnerability but the node on the sensory-related thalamus increased in patients with GRE and chromosome 1p/19q co-deletion. Decreased shortest path length, grade 2, and decreased nodal betweenness centrality of the premotor area were risk factors for GRE. CONCLUSION Decreased shortest path length was a characteristic alteration in GRE and prefrontal glioma. Alterations in global properties were similar, but nodal properties were different in patients with GRE and different chromosome 1p/19q statuses.
Collapse
Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Beijing, China
| | - Lianwang Li
- Beijing Neurosurgical Institute, Beijing, China
| | | | - Yuhao Guo
- Beijing Neurosurgical Institute, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Beijing, China.,Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain Tumors, Chinese Academy of Medical Sciences, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
40
|
Maguire MJ, Fairclough S, Nevitt SJ. Antiepileptic drugs for treating seizures in people with brain tumours. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023. [PMCID: PMC9890922 DOI: 10.1002/14651858.cd015467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To compare the efficacy and tolerability of antiepileptic drugs (AEDs) taken as monotherapy or add‐on therapy for seizures in people with brain tumours.
Collapse
Affiliation(s)
| | | | | | - Sarah J Nevitt
- Department of Health Data ScienceUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
41
|
Ollila L, Roivainen R. Glioma features and seizure control during long-term follow-up. Epilepsy Behav Rep 2023; 21:100586. [PMID: 36712600 PMCID: PMC9874012 DOI: 10.1016/j.ebr.2023.100586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background An epileptic seizure is a common presenting symptom of glioma, or epilepsy may develop later during the disease. Epileptic seizures affect the quality of life in patients with glioma. Good seizure control during 6-12 months follow-up has been associated with gross total resection, radiation therapy and chemotherapy of gliomas. Little is known about seizure control during long-term follow-up and about factors which may affect the prognosis of epilepsy in glioma patients. Methods We identified retrospectively all adult patients with diffuse glioma (grade 2-4) associated epilepsy (n = 123) living in Helsinki, who received treatment at Helsinki University Hospital neuro-oncology center during 2013-2015. We excluded patients with histopathological diagnosis prior to 2005. Data was collected from medical records for five years after diagnosis of glioma, or until death. Results In this patient cohort 49 (39.8 %) had grade 2 glioma, 19 (15.4 %) had grade 3 glioma and 55 (44.7 %) had grade 4 glioma. 29 (23.6 %) of tumors were astrocytomas, 24 (19.5 %) were oligoastrocytomas, 15 (12.2 %) were oligodendrogliomas and 55 (44.7 %) were glioblastomas. A seizure was the presenting symptom in 87 (70.7 %) of the patients. The majority, 68 (57.6 %) patients were seizure-free for at least 12 months at some point during follow-up and 47 (39.8 %) patients were seizure-free during the last year of follow-up. Survival for five years from glioma diagnosis (p < 0.001), lower grade of tumor (p < 0.001), IDH mutation (p < 0.001), epilepsy as first symptom (p < 0.001), younger age (p < 0.001) and lack of progression (p = 0.021) correlated with seizure freedom at the end of follow-up. When the results were analyzed separately in survivors and deceased patients, only progression correlated negatively with seizure freedom at the end of follow-up in surviving patients (p = 0.008). In 5-year survivors, longer seizure-free periods were achieved by patients without progression of glioma (p = 0.040) vs patients with progression, or without focal aware (p 0.003) or focal impaired awareness seizures (p = 0.002) vs patients with only focal to bilateral tonic-clonic seizures. In deceased patients, progression (p < 0.001) and lower grade of glioma (p = 0.003) correlated positively and focal aware seizures negatively (p = 0.021) with a longer seizure-free period. In all patients, freedom of seizures at the end of follow-up was less likely for patients who had focal aware (p = 0.015) than for patients without focal aware seizures. Conclusion There are differences in seizure-free times in patients with grade 2-4 glioma and epilepsy. The results suggest that the prognosis of glioma may be the most important factor influencing the prognosis of epilepsy.
Collapse
Affiliation(s)
- Leena Ollila
- Corresponding author at: Dept of Neurology, Helsinki University Hospital, P.O. Box 340, 00290 Helsinki, Finland.
| | | |
Collapse
|
42
|
Fairclough S, Goodden J, Chumas P, Mathew R, Maguire M. Levetiracetam as a first-line antiseizure medication in WHO grade 2 glioma: Time to seizure freedom and rates of treatment failure. Epilepsia 2023; 64:857-865. [PMID: 36636895 DOI: 10.1111/epi.17508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The high seizure burden seen in World Health Association (WHO) grade 2 gliomas is well documented. This study aims to identify factors that influence the probability of seizure freedom (12 months of seizure remission) and treatment failure (antiseizure medication [ASM] cessation or introduction of an alternative) in patients with WHO grade 2 glioma. METHODS This is a retrospective observational analysis of patients from a regional UK neurosurgical center with histologically proven (n = 146) WHO grade 2 glioma and brain tumor related epilepsy. Statistical analyses using both Kaplan-Meier and Cox proportional hazards models were undertaken, with a particular focus on treatment outcomes when the commonly prescribed ASM levetiracetam (n = 101) is used as first line. RESULTS Treatment with levetiracetam as a first-line ASM resulted in a significant increase in the probability of seizure freedom (p < .05) at 2 years compared with treatment with an alternative ASM. Individuals presenting with focal seizures without bilateral tonic-clonic progression were between 39% and 42% significantly less likely to reach seizure freedom within 10 years (p < .05) and 132% more likely to fail treatment by 5 years (p < .01) when compared to individuals who had seizures with progression to bilateral tonic-clonic activity. ASM choice did not significantly affect treatment failure rates. SIGNIFICANCE More than two-thirds of patients with WHO grade 2 glioma related epilepsy treated with levetiracetam first line achieve seizure freedom within 2 years and it is a reasonable first-choice agent. Experiencing mainly focal seizures without progression infers a significant long-term reduction in the chance of seizure freedom. Further studies are needed to inform ASM selection.
Collapse
Affiliation(s)
- Sam Fairclough
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK.,Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - John Goodden
- Neurosurgery Department, Leeds Teaching Hospitals, Leeds, UK
| | - Paul Chumas
- Neurosurgery Department, Leeds Teaching Hospitals, Leeds, UK
| | - Ryan Mathew
- Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Neurosurgery Department, Leeds Teaching Hospitals, Leeds, UK
| | - Melissa Maguire
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK.,Faculty of Medicine and Health, University of Leeds, Leeds, UK
| |
Collapse
|
43
|
Selvarajah D, Lam A, Fadia M, McDowell D. Adult pilomyxoid astrocytoma presenting in the temporal lobe. Heliyon 2023; 9:e12909. [PMID: 36685361 PMCID: PMC9853359 DOI: 10.1016/j.heliyon.2023.e12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/08/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Pilomyxoid astrocytoma (PMA) is a rare variant of astrocytoma that is usually present in the hypothalamic and chiasmatic areas in the paediatric population. PMA shares many similar histopathological features to Pilocytic astrocytoma (PA), with some notable differences in its radiological and histopathological findings. On the contrary, PMA has been reported to behave more aggressively in its clinical progression than PA. Here, we describe a rare case of PMA in a 25-year-old female involving the temporal lobe, presenting with recurrent partial seizures. To our knowledge, this is the first reported case of PMA presenting in the temporal lobe in an adult female with an atypical location of the tumour, uncommon age group, and unusual radiological features being unique in this case report.
Collapse
Affiliation(s)
- Denesh Selvarajah
- Medical Officer, Department of Neurosurgery, The Canberra Hospital; MChD, Australia,Corresponding author. Resident Medical Officer, Department of Neurosurgery The Canberra Hospital, Yamba Dr, Garran ACT 2605 Australia.
| | - Alexander Lam
- Neurosurgical Registrar, Department of Neurosurgery, The Canberra Hospital; MChD, Australia
| | - Mitali Fadia
- Consultant Pathologist, Department of Pathology, The Canberra Hospital; FRCPA, Australia
| | - David McDowell
- Consultant Neurosurgeon, Head of Department, Department of Neurosurgery, The Canberra Hospital; FRACS, Australia
| |
Collapse
|
44
|
Wu PB, Filley AC, Miller ML, Bruce JN. Benign Glioma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:31-71. [PMID: 37452934 DOI: 10.1007/978-3-031-23705-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign glioma broadly refers to a heterogeneous group of slow-growing glial tumors with low proliferative rates and a more indolent clinical course. These tumors may also be described as "low-grade" glioma (LGG) and are classified as WHO grade I or II lesions according to the Classification of Tumors of the Central Nervous System (CNS) (Louis et al. in Acta Neuropathol 114:97-109, 2007). Advances in molecular genetics have improved understanding of glioma tumorigenesis, leading to the identification of common mutation profiles with significant treatment and prognostic implications. The most recent WHO 2016 classification system has introduced several notable changes in the way that gliomas are diagnosed, with a new emphasis on molecular features as key factors in differentiation (Wesseling and Capper in Neuropathol Appl Neurobiol 44:139-150, 2018). Benign gliomas have a predilection for younger patients and are among the most frequently diagnosed tumors in children and young adults (Ostrom et al. in Neuro Oncol 22:iv1-iv96, 2020). These tumors can be separated into two clinically distinct subgroups. The first group is of focal, well-circumscribed lesions that notably are not associated with an increased risk of malignant transformation. Primarily diagnosed in pediatric patients, these WHO grade I tumors may be cured with surgical resection alone (Sturm et al. in J Clin Oncol 35:2370-2377, 2017). Recurrence rates are low, and the prognosis for these patients is excellent (Ostrom et al. in Neuro Oncol 22:iv1-iv96, 2020). Diffuse gliomas are WHO grade II lesions with a more infiltrative pattern of growth and high propensity for recurrence. These tumors are primarily diagnosed in young adult patients, and classically present with seizures (Pallud et al. Brain 137:449-462, 2014). The term "benign" is a misnomer in many cases, as the natural history of these tumors is with malignant transformation and recurrence as grade III or grade IV tumors (Jooma et al. in J Neurosurg 14:356-363, 2019). For all LGG, surgery with maximal safe resection is the treatment of choice for both primary and recurrent tumors. The goal of surgery should be for gross total resection (GTR), as complete tumor removal is associated with higher rates of tumor control and seizure freedom. Chemotherapy and radiation therapy (RT), while not typically a component of first-line treatment in most cases, may be employed as adjunctive therapy in high-risk or recurrent tumors and in some select cases. The prognosis of benign gliomas varies widely; non-infiltrative tumor subtypes generally have an excellent prognosis, while diffusely infiltrative tumors, although slow-growing, are eventually fatal (Sturm et al. in J Clin Oncol 35:2370-2377, 2017). This chapter reviews the shared and unique individual features of the benign glioma including diffuse glioma, pilocytic astrocytoma and pilomyxoid astrocytoma (PMA), subependymal giant cell astrocytoma (SEGA), pleomorphic xanthoastrocytoma (PXA), subependymoma (SE), angiocentric glioma (AG), and chordoid glioma (CG). Also discussed is ganglioglioma (GG), a mixed neuronal-glial tumor that represents a notable diagnosis in the differential for other LGG (Wesseling and Capper 2018). Ependymomas of the brain and spinal cord, including major histologic subtypes, are discussed in other chapters.
Collapse
Affiliation(s)
- Peter B Wu
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, UCLA, Los Angeles, USA
| | - Anna C Filley
- Department of Neurosurgery, Columbia University Medical Center, New York, USA
| | - Michael L Miller
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Jeffrey N Bruce
- Department of Neurosurgery, Columbia University Medical Center, New York, USA.
| |
Collapse
|
45
|
Zhang K, Liu D, Yang Z, Li X, Yang Z, He X. Resective surgery for patients with frontal lobe diffuse low-grade glioma-related epilepsy: predictors of seizure outcomes. Ther Adv Chronic Dis 2022; 13:20406223221141856. [PMID: 36545237 PMCID: PMC9761231 DOI: 10.1177/20406223221141856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background Diffuse low-grade gliomas (DLGGs) are prone to invade the frontal lobes, with seizures being the most common symptom. However, limited attention has been paid to surgical outcomes and their predictors in patients with frontal DLGG-related epilepsy. Objective This study aimed to analyze predictors of postoperative seizure outcomes in patients with frontal DLGG-related epilepsy. Design This is a single-center retrospective study. Methods This study retrospectively collected data of 115 patients with frontal DLGG-related epilepsy who underwent resective surgery between January 2014 and January 2021. Patients were categorized into favorable and unfavorable seizure outcome groups based on the International League Against Epilepsy (ILAE) classification. Univariate and multivariate analyses were used to identify potential predictors of seizure outcomes. Results The mean follow-up was 4.11 ± 2.06 years, and 77.4% (89 of 115) of patients were seizure-free. Permanent neurological deficits were observed in 7.0% (8 of 115) of patients. Univariate and multivariate analyses revealed that total tumor removal [odds ratio (OR), 0.31; 95% confidence interval (CI), 0.12-0.82; p = 0.018] and older age at seizure onset (OR, 0.96; 95% CI, 0.93-0.99; p = 0.042) were independent predictors of favorable seizure outcomes. Conclusion Surgical resection is an effective treatment for frontal DLGG-related epilepsy. Favorable seizure outcomes are more likely to be achieved in patients with complete tumor removal and those with older age at seizure onset.
Collapse
Affiliation(s)
- Kai Zhang
- Department of Neurosurgery, Xiangya Hospital,
Central South University, Changsha, People’s Republic of China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital,
Central South University, Changsha, People’s Republic of China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital,
Central South University, Changsha, People’s Republic of China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital,
Central South University, Changsha, People’s Republic of China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital,
Central South University, Changsha, People’s Republic of China
| | | |
Collapse
|
46
|
He X, Zhang K, Liu D, Yang Z, Li X, Yang Z. Predictors of seizure outcomes in patients with diffuse low-grade glioma-related epilepsy after complete glioma removal. CNS Neurosci Ther 2022; 29:736-743. [PMID: 36514187 PMCID: PMC9873512 DOI: 10.1111/cns.14061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/11/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS We aimed to identify predictors of postoperative seizures in patients with diffuse low-grade glioma (DLGG)-related epilepsy after complete tumor resection in this study. METHODS We retrospectively collected data from individuals with DLGG-related epilepsy whose tumors were completely resected at Xiangya Hospital, Central South University between January 2014 and January 2020. The predictors of seizure outcomes were assessed by employing univariate analysis and a multivariate logistic regression model in a backward binary logistic regression model. RESULTS Among the 118 cases that met the inclusion criteria, 83.05% were seizure-free following an average follow-up of 4.27 ± 1.65 years, all of whom were classified as International League Against Epilepsy class I outcome. Univariate and multivariate analyses indicated that seizure duration of >6 years (odds ratio [OR], 6.62; 95% confidence interval [CI], 1.76-24.98; p = 0.005) and first clinical symptoms other than seizures (OR, 4.51; 95% CI, 1.43-14.23; p = 1.010) were both independent predictors of unfavorable seizure outcomes. CONCLUSION Our results imply that satisfactory seizure outcomes can be achieved in most patients with DLGG-related epilepsy after complete tumor resection. Patients with seizure duration of >6 years or first clinical symptoms other than seizures were more likely to experience postoperative seizure recurrence.
Collapse
Affiliation(s)
- Xinghui He
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Kai Zhang
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Xuejun Li
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| |
Collapse
|
47
|
Prevalence of seizures in brain tumor: A meta-analysis. Epilepsy Res 2022; 187:107033. [DOI: 10.1016/j.eplepsyres.2022.107033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
|
48
|
Sánchez-Villalobos JM, Aledo-Serrano Á, Villegas-Martínez I, Shaikh MF, Alcaraz M. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Front Pharmacol 2022; 13:991244. [PMID: 36278161 PMCID: PMC9583251 DOI: 10.3389/fphar.2022.991244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.
Collapse
Affiliation(s)
- José Manuel Sánchez-Villalobos
- Department of Neurology, University Hospital Complex of Cartagena, Murcia, Spain
- Department of Cell Biology and Histology, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
- *Correspondence: Ángel Aledo-Serrano,
| | | | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Miguel Alcaraz
- Department of Radiology and Physical Medicine, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| |
Collapse
|
49
|
Altered Extracellular Matrix as an Alternative Risk Factor for Epileptogenicity in Brain Tumors. Biomedicines 2022; 10:biomedicines10102475. [PMID: 36289737 PMCID: PMC9599244 DOI: 10.3390/biomedicines10102475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Seizures are one of the most common symptoms of brain tumors. The incidence of seizures differs among brain tumor type, grade, location and size, but paediatric-type diffuse low-grade gliomas/glioneuronal tumors are often highly epileptogenic. The extracellular matrix (ECM) is known to play a role in epileptogenesis and tumorigenesis because it is involved in the (re)modelling of neuronal connections and cell-cell signaling. In this review, we discuss the epileptogenicity of brain tumors with a focus on tumor type, location, genetics and the role of the extracellular matrix. In addition to functional problems, epileptogenic tumors can lead to increased morbidity and mortality, stigmatization and life-long care. The health advantages can be major if the epileptogenic properties of brain tumors are better understood. Surgical resection is the most common treatment of epilepsy-associated tumors, but post-surgery seizure-freedom is not always achieved. Therefore, we also discuss potential novel therapies aiming to restore ECM function.
Collapse
|
50
|
The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review. Acta Neurochir (Wien) 2022; 164:2789-2809. [PMID: 35945356 DOI: 10.1007/s00701-022-05339-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/02/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE For a long time, return to work (RTW) has been neglected in patients harboring a diffuse low-grade glioma (LGG). However, a majority of LGG patients worked at time of diagnosis. Moreover, these patients now live longer given current treatment paradigms, especially thanks to early maximal surgery. METHODS We systematically searched available medical databases for studies that reported data on RTW in patients who underwent resection for LGG. RESULTS A total of 30 studies were selected: 19 considered RTW (especially rate and timing) as an outcome and 11 used scales of health-related quality of life (HRQoL) which included work-related aspects. Series that considered RTW as a main endpoint were composed of 1014 patients, with postoperative RTW rates ranging from 31 to 97.1% (mean 73.1%). Timing to RTW ranged from 15 days to 22 months (mean 6.3 months). Factors related to an increased proportion of RTW were: younger age, better neurologic status, having a white-collar occupation, working pre-operatively, being the sole breadwinner, the use of awake surgery, and greater extent of resection. Female sex, older age, poor neurologic status, pre-operative history of work absences, slow lexical access speed, and postoperative seizures were negatively related to RTW. No studies that used HRQoL scales directly investigated RTW rate or timing. CONCLUSIONS RTW was scarcely analyzed in LGG patients who underwent resection. However, because they are usually young, with no or only mild functional deficits and have a longer life expectancy, postoperative RTW should be assessed more systematically and accurately as a main outcome. As majority (61.5-100%) of LGG patients were working at time of surgery, the responsibility of neurosurgeons is to bring these patients back to their previous activities according to his/her wishes. RTW might also be included as a critical endpoint for future prospective studies and randomized control trials on LGGs.
Collapse
|