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Du Y, Li R, Fu D, Zhang B, Cui A, Shao Y, Lai Z, Chen R, Chen B, Wang Z, Zhang W, Chu L. Multi-omics technologies and molecular biomarkers in brain tumor-related epilepsy. CNS Neurosci Ther 2024; 30:e14717. [PMID: 38641945 PMCID: PMC11031674 DOI: 10.1111/cns.14717] [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: 11/17/2023] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Brain tumors are one of the leading causes of epilepsy, and brain tumor-related epilepsy (BTRE) is recognized as the major cause of intractable epilepsy, resulting in huge treatment cost and burden to patients, their families, and society. Although optimal treatment regimens are available, the majority of patients with BTRE show poor resolution of symptoms. BTRE has a very complex and multifactorial etiology, which includes several influencing factors such as genetic and molecular biomarkers. Advances in multi-omics technologies have enabled to elucidate the pathophysiological mechanisms and related biomarkers of BTRE. Here, we reviewed multi-omics technology-based research studies on BTRE published in the last few decades and discussed the present status, development, opportunities, challenges, and prospects in treating BTRE. METHODS First, we provided a general review of epilepsy, BTRE, and multi-omics techniques. Next, we described the specific multi-omics (including genomics, transcriptomics, epigenomics, proteomics, and metabolomics) techniques and related molecular biomarkers for BTRE. We then presented the associated pathogenetic mechanisms of BTRE. Finally, we discussed the development and application of novel omics techniques for diagnosing and treating BTRE. RESULTS Genomics studies have shown that the BRAF gene plays a role in BTRE development. Furthermore, the BRAF V600E variant was found to induce epileptogenesis in the neuronal cell lineage and tumorigenesis in the glial cell lineage. Several genomics studies have linked IDH variants with glioma-related epilepsy, and the overproduction of D2HG is considered to play a role in neuronal excitation that leads to seizure occurrence. The high expression level of Forkhead Box O4 (FOXO4) was associated with a reduced risk of epilepsy occurrence. In transcriptomics studies, VLGR1 was noted as a biomarker of epileptic onset in patients. Several miRNAs such as miR-128 and miRNA-196b participate in BTRE development. miR-128 might be negatively associated with the possibility of tumor-related epilepsy development. The lncRNA UBE2R2-AS1 inhibits the growth and invasion of glioma cells and promotes apoptosis. Quantitative proteomics has been used to determine dynamic changes of protein acetylation in epileptic and non-epileptic gliomas. In another proteomics study, a high expression of AQP-4 was detected in the brain of GBM patients with seizures. By using quantitative RT-PCR and immunohistochemistry assay, a study revealed that patients with astrocytomas and oligoastrocytomas showed high BCL2A1 expression and poor seizure control. By performing immunohistochemistry, several studies have reported the relationship between D2HG overproduction and seizure occurrence. Ki-67 overexpression in WHO grade II gliomas was found to be associated with poor postoperative seizure control. According to metabolomics research, the PI3K/AKT/mTOR pathway is associated with the development of glioma-related epileptogenesis. Another metabolomics study found that SV2A, P-gb, and CAD65/67 have the potential to function as biomarkers for BTRE. CONCLUSIONS Based on the synthesized information, this review provided new research perspectives and insights into the early diagnosis, etiological factors, and personalized treatment of BTRE.
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Affiliation(s)
- Yaoqiang Du
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
| | - Rusong Li
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Danqing Fu
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
| | - Biqin Zhang
- Cancer Center, Department of HematologyZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Ailin Cui
- Cancer Center, Department of Ultrasound MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Yutian Shao
- Zhejiang BioAsia Life Science InstitutePinghuChina
| | - Zeyu Lai
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Rongrong Chen
- School of Clinical MedicineHangzhou Normal UniversityHangzhouChina
| | - Bingyu Chen
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Zhen Wang
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Wei Zhang
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Lisheng Chu
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
- Department of PhysiologyZhejiang Chinese Medical UniversityHangzhouChina
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2
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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.
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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
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3
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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]
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4
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Pienkowski T, Kowalczyk T, Garcia-Romero N, Ayuso-Sacido A, Ciborowski M. Proteomics and metabolomics approach in adult and pediatric glioma diagnostics. Biochim Biophys Acta Rev Cancer 2022; 1877:188721. [PMID: 35304294 DOI: 10.1016/j.bbcan.2022.188721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/26/2022]
Abstract
The diagnosis of glioma is mainly based on imaging methods that do not distinguish between stage and subtype prior to histopathological analysis. Patients with gliomas are generally diagnosed in the symptomatic stage of the disease. Additionally, healing scar tissue may be mistakenly identified based on magnetic resonance imaging (MRI) as a false positive tumor recurrence in postoperative patients. Current knowledge of molecular alterations underlying gliomagenesis and identification of tumoral biomarkers allow for their use as discriminators of the state of the organism. Moreover, a multiomics approach provides the greatest spectrum and the ability to track physiological changes and can serve as a minimally invasive method for diagnosing asymptomatic gliomas, preceding surgery and allowing for the initiation of prophylactic treatment. It is important to create a vast biomarker library for adults and pediatric patients due to their metabolic differences. This review focuses on the most promising proteomic, metabolomic and lipidomic glioma biomarkers, their pathways, the interactions, and correlations that can be considered characteristic of tumor grade or specific subtype.
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Affiliation(s)
- Tomasz Pienkowski
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland.
| | - Tomasz Kowalczyk
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland; Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland
| | - Noemi Garcia-Romero
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223 Madrid, Spain; Brain Tumor Laboratory, Fundación Vithas, Grupo Hospitales Vithas, 28043 Madrid, Spain
| | - Angel Ayuso-Sacido
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223 Madrid, Spain; Brain Tumor Laboratory, Fundación Vithas, Grupo Hospitales Vithas, 28043 Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Michal Ciborowski
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
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Samudra N, Zacharias T, Plitt A, Lega B, Pan E. Seizures in glioma patients: An overview of incidence, etiology, and therapies. J Neurol Sci 2019; 404:80-85. [PMID: 31352293 DOI: 10.1016/j.jns.2019.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/24/2019] [Accepted: 07/18/2019] [Indexed: 12/19/2022]
Abstract
Gliomas are fatal brain tumors, and even low-grade gliomas (LGGs) have an average survival of less than a decade. Seizures are a common presentation of gliomas, particularly LGGs, and substantially impact quality of life. Glioma-related seizures differ from other focal epilepsies in their pathogenesis and in the likelihood of refractory epilepsy. We review factors that predict seizure activity and response to treatment, optimal pharmacologic and surgical management of glioma-related epilepsy, and the benefit of using newer anti-seizure medications in patients with gliomas. As surgery is so often beneficial with seizure reduction, we discuss oncologic and epilepsy surgery perspectives. Treatment of gliomas has the potential to ameliorate seizures and increase rates of seizure freedom. Prospective, well-powered studies are needed to provide more definitive answers for practitioners taking care of glioma patients with seizures.
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Affiliation(s)
- Niyatee Samudra
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Tresa Zacharias
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Aaron Plitt
- Department of Neurosurgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Bradley Lega
- Department of Neurosurgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Edward Pan
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
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Abstract
The World Health Organization classifies diffuse low-grade gliomas (DLGGs) are highly epileptogenic primary brain tumors; epileptic seizures occur in more than 90% of cases. Epileptic seizures and drug resistance progress during the course of DLGGs. The glioma-related epileptogenic mechanisms are multifactorial; epileptogenic foci lie within the infiltrated peritumoral neocortex. A short seizure duration before surgery and a large extent of resection are the main predictors of postoperative seizure control in DLGGs. A supratotal resection of a DLGG can improve postoperative seizure control. Epileptic seizure at diagnosis positively affects DLGGs malignant transformation and overall survival.
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Affiliation(s)
- Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, 1 rue Cabanis, Paris Cedex 14 75674, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; French Glioma Study Group, Réseau d'Etude des Gliomes, REG, Groland, France; Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France.
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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7
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Zhang J, Yao L, Peng S, Fang Y, Tang R, Liu J. Correlation between glioma location and preoperative seizures: a systematic review and meta-analysis. Neurosurg Rev 2018; 42:603-618. [PMID: 30073426 DOI: 10.1007/s10143-018-1014-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 12/28/2022]
Abstract
Epilepsy is a common manifestation of glioma patients and negatively impacts on quality of life and neurocognitive function. The risk of preoperative seizures in patients with glioma is currently under discussion. We aimed to evaluate the relationship between tumor locations in the cerebrum and preoperative seizures in patients with glioma. PubMed, EMBASE, Web of Science, China Biology Medicine, and the Cochrane Library were systematically searched from inception to July 15, 2017, for original studies including reports of preoperative seizures in patients with gliomas in different brain regions. The pooled odds ratio (OR) and 95% confidence interval (CI) of the meta-analysis for preoperative seizure risk stratified by cerebrum regions were calculated. The quality of evidence was assessed per outcome, using the approach of the Grades of Recommendation, Assessment, Development and Evaluation. Overall, 4323 participants in 16 population-based studies were included in this meta-analysis. The meta-analysis indicated that gliomas in the frontal lobe (OR = 1.51, 95% CI = 1.09-2.09, P = 0.013) were associated with a higher risk for preoperative seizure compared to occipital lobe involved (OR = 0.53, 95% CI = 0.32-0.88, P = 0.014). Regarding the other three lobe involved gliomas, no difference was found between the incidence of preoperative seizures and tumor location. Current limited data suggest that frontal gliomas were associated with a higher risk of preoperative seizures, while gliomas in the occipital lobe were associated with a lower seizure risk. Further RCT studies recruiting larger sample sizes are required to validate these results and guide clinical practice.
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Affiliation(s)
- Jian Zhang
- Department of Neurology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Liang Yao
- Clinical Evidence Based Medicine Center, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Shaopeng Peng
- Department of Neurology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Yuan Fang
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China
| | - Ruitian Tang
- School of Clinical Medical Sciences, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jianxiong Liu
- Department of Neurology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, China.
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8
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Liu Z, Wang Y, Liu X, Du Y, Tang Z, Wang K, Wei J, Dong D, Zang Y, Dai J, Jiang T, Tian J. Radiomics analysis allows for precise prediction of epilepsy in patients with low-grade gliomas. Neuroimage Clin 2018; 19:271-278. [PMID: 30035021 PMCID: PMC6051495 DOI: 10.1016/j.nicl.2018.04.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/11/2018] [Accepted: 04/22/2018] [Indexed: 01/08/2023]
Abstract
Purpose To investigate the association between imaging features and low-grade gliomas (LGG) related epilepsy, and to propose a radiomics-based model for the prediction of LGG-associated epilepsy. Methods This retrospective study consecutively enrolled 286 patients with LGGs (194 in the primary cohort and 92 in the validation cohort). T2-weighted MR images (T2WI) were used to characterize risk factors for LGG-related epilepsy: Tumor location features and 3-D imaging features were determined, following which the interactions between these two kinds of features were analyzed. Elastic net was applied to generate a radiomics signature combining key imaging features associated with the LGG-related epilepsy with the primary cohort, and then a nomogram incorporating radiomics signature and clinical characteristics was developed. The radiomics signature and nomogram were validated in the validation cohort. Results A total of 475 features associated with LGG-related epilepsy were obtained for each patient. A radiomics signature with eleven selected features allowed for discriminating patients with epilepsy or not was detected, which performed better than location and 3-D imaging features. The nomogram incorporating radiomics signature and clinical characteristics achieved a high degree of discrimination with area under receiver operating characteristic (ROC) curve (AUC) at 0.8769 in the primary cohort and 0.8152 in the validation cohort. The nomogram also allowed for good calibration in the primary cohort. Conclusion We developed and validated an effective prediction model for LGG-related epilepsy. Our results suggested that radiomics analysis may enable more precise and individualized prediction of LGG-related epilepsy.
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Affiliation(s)
- Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing 100190, China
| | - Yinyan Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China
| | - Xing Liu
- Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China
| | - Yang Du
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing 100190, China
| | - Zhenchao Tang
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, Shandong Province 264209, China
| | - Kai Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Jingwei Wei
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing 100190, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing 100190, China
| | - Yali Zang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing 100190, China
| | - Jianping Dai
- Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Tao Jiang
- Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100080, China.
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9
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Wang Z, Yang P, You G, Zhang W, Bao ZS, Jiang T, Zhang CB. Predicting the likelihood of postoperative seizure status based on mRNA sequencing in low-grade gliomas. Future Oncol 2017; 14:545-552. [PMID: 29206064 DOI: 10.2217/fon-2017-0590] [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: 11/21/2022] Open
Abstract
AIM No comprehensive and objective methods yet exist for predicting postoperative seizure. PATIENTS & METHODS mRNA-seq data and corresponding postoperative seizure status of 109 low-grade glioma samples were obtained from Chinese Glioma Genome Atlas database and divided into two sets randomly. Logistic regression and receiver operating characteristic analysis with risk score method were used to develop a ten-gene prediction model. RESULTS Considering gene number and area under the curve of receiver operating characteristic, a ten-gene model was generated which showed an area under the curve of 0.9965 in training set. Patients with high-risk scores had higher probability of postoperative seizure compared with those with low-risk scores. CONCLUSION This is the first prediction model for postoperative seizures in gliomas, integrating multiple genes. Clinical application may help patients with postoperative seizure control.
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Affiliation(s)
- Zheng Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, PR China
| | - Pei Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Gan You
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Zhao-Shi Bao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, PR China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.,China National Clinical Research Center for Neurological Diseases, Beijing, PR China.,Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, PR China
| | - Chuan-Bao Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, PR China
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10
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Wang Y, Tang K, Zhao J, Liu L, Feng J. FOXO4 expression is associated with the occurrence and outcome of seizures: An RNA-sequencing analysis of low-grade gliomas. Seizure 2017; 52:41-45. [PMID: 28963932 DOI: 10.1016/j.seizure.2017.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Epileptic seizures account for most of the initial symptoms in patients with low-grade gliomas (LGGs). Nevertheless, the molecular mechanisms of tumor-associated seizures remain unclear. This study investigated the genetic changes associated with the occurrence and outcome of seizures in patients with LGGs. METHODS The clinical characteristics and gene profile data of 86 patients with LGGs were collected from the Chinese Glioma Genome Atlas database. Gene expression was analyzed based on whole-genome RNA sequencing. The genes with significantly different expressions between patients with and without seizures were identified. Additionally, the Engel Epilepsy Surgery Outcome Scale was applied to evaluate the seizure outcomes at 6 months after tumor resection. RESULTS In patients with LGGs, the expression of Forkhead Box O4 (FOXO4) was significantly different between the seizure and non-seizure groups, and high FOXO4 expression was found to be associated with a low risk of seizure occurrences (p=0.026). This result was validated by using the clinical information and RNA sequence data from The Cancer Genome Atlas database (p=0.005). FOXO4 was additionally identified as a predictor of seizure outcomes in patients with LGGs at 6 months after tumor resection (p=0.018). CONCLUSIONS The results of our genomic analysis suggest that low FOXO4 expression is a significant risk factor for epileptic seizures in patients with LGGs and is associated with the seizure outcome. FOXO4 may be a potential therapeutic target for tumor-associated epilepsy.
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Affiliation(s)
- Yongheng Wang
- Department of Neurosurgery, Qinhuangdao First Hospital, Qinhuangdao, Hebei Province 066000, China
| | - Kai Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Jianhua Zhao
- Department of Neurosurgery, Qinhuangdao First Hospital, Qinhuangdao, Hebei Province 066000, China
| | - Li Liu
- Department of Ophthalmology, Qinhuangdao First Hospital, Qinhuangdao, Hebei Province 066000, China.
| | - Ji Feng
- Department of Neurosurgery, Qinhuangdao First Hospital, Qinhuangdao, Hebei Province 066000, China.
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11
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Affiliation(s)
- Ling Feng
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, Beijing , China
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12
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Huang C, Chi XS, Hu X, Chen N, Zhou Q, Zhou D, Li JM. Predictors and mechanisms of epilepsy occurrence in cerebral gliomas: What to look for in clinicopathology. Exp Mol Pathol 2017; 102:115-122. [PMID: 28087392 DOI: 10.1016/j.yexmp.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 02/05/2023]
Abstract
Gliomas, especially low-grade gliomas, are highly epileptogenic brain tumors. Histopathological information is valuable in evaluating the diagnosis and/or biologic behavior of various gliomas. Here we explored the clinical data and histopathological predictors of the occurrence of epilepsy in patients with gliomas. A retrospective study examined 310 consecutive patients who had undergone surgical treatment for gliomas in our institution from January 2013 to January 2015. Clinical data and pathological examination results were analyzed. Literatures regarding the predictors and etiology of glioma associated epileptic seizures in the period of 1995-2015 were also reviewed. A total of 234 (75.5%) astrocytic tumors and 76 (24.5%) oligodendrial tumors were included. At diagnosis, 33.6% of patients had epileptic seizures. Multivariate analysis revealed cortex involvement (OR=7.991, 95%CI=1.599-39.926), lower World Health Organization grade (OR=3.584, 95%CI=1.032-12.346) and topoisomerase II (TopoII) positivity (OR=0.943, 95%CI=0.903-0.982) were strong predictors for preoperative epileptic seizures. Gender, disease course, tumor classification, location or volume did not significantly affect epileptic seizure occurrence. Forty-three publications involved glioma-associated epilepsy were found in PubMed online database and key data were extracted and summarized. The present studies on glioma-related epilepsy are relatively limited and inconsistent. Low-grade gliomas, cortex involvement and TopoII positivity were independent predictors of a history of epileptic seizures at diagnosis. Further studies to examine the underlying mechanism of topoisomerase II as well as other molecules in epilepsy occurrence in brain gliomas are needed in the future.
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Affiliation(s)
- Cheng Huang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China; Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Xiao-Sa Chi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Qiao Zhou
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jin-Mei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China.
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13
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Zhou XW, Wang X, Yang Y, Luo JW, Dong H, Liu YH, Mao Q. Biomarkers related with seizure risk in glioma patients: A systematic review. Clin Neurol Neurosurg 2016; 151:113-119. [PMID: 27821299 DOI: 10.1016/j.clineuro.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/03/2016] [Indexed: 02/05/2023]
Abstract
Increasing evidence indicates that genetic biomarkers play important roles in the development of glioma-associated seizures. Thus, we performed a systematic review to summarise biomarkers that are associated with seizures in glioma patients. An electronic literature search of public databases (PubMed, Embase and Medline) was performed using the keywords glioma, seizure and epilepsy. A totall of 26 eligible studies with 2224 cases were included in this systematic review of publications to 20 June, 2016. Genetic biomarkers such as isocitrate dehydrogenase 1 (IDH1) mutations, low expression of excitatory amino acid transporter 2 (EAAT2), high xCT expression, overexpression of adenosine kinase (ADK) and low expression of very large G-protein-coupled receptor-1 (VLGR1) are primarily involved in synaptic transmission, whereas BRAF mutations, epidermal growth factor receptor (EGFR) amplification, miR-196b expression and low ki-67 expression are associated with regulation of cell proliferation. However, there is limited evidence regarding the roles of RAD50 interactor 1 (RINT1) and olig2 in epileptogenesis among glioma patients. Glioma-related seizure was related to the dysfunction of tumor microenvironment. Our findings may provide new mechanistic insights into targeted therapy for glioma-related seizures and may result in the development of multi-target therapies.
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Affiliation(s)
- Xing-Wang Zhou
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Xiang Wang
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Jie-Wen Luo
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Hui Dong
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Yan-Hui Liu
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China.
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Yang P, Cai J, Yan W, Zhang W, Wang Y, Chen B, Li G, Li S, Wu C, Yao K, Li W, Peng X, You Y, Chen L, Jiang C, Qiu X, Jiang T. Classification based on mutations of TERT promoter and IDH characterizes subtypes in grade II/III gliomas. Neuro Oncol 2016; 18:1099-108. [PMID: 26957363 DOI: 10.1093/neuonc/now021] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 01/23/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Grade II and III gliomas have variable clinical behaviors, showing the distinct molecular genetic alterations from glioblastoma (GBM), many of which eventually transform into more aggressive tumors. Since the classifications of grade II/III gliomas based on the genetic alterations have been recently emerging, it is now a trend to include molecular data into the standard diagnostic algorithm of glioma. METHODS Here we sequenced TERT promoter mutational status (TERTp-mut) in the DNA of 377 grade II/III gliomas and analyzed the clinical factors, molecular aberrations, and transcriptome profiles. RESULTS We found that TERTp-mut occurred in 145 of 377 grade II and III gliomas (38.5%), mutually exclusive with a TP53 mutation (TP53-mut; P < .001) and coincident with a 1p/19q co-deletion (P = .002). TERTp-mut was an independent predictive factor of a good prognosis in all patients (P = .048). It has been an independent factor associated with a good outcome in the IDH mutation (IDH-mut) subgroup (P = .018), but it has also been associated with a poor outcome in the IDH wild-type (IDH-wt) subgroup (P = .049). Combining TERTp-mut and IDH-mut allowed the grade II/III malignancies to be reclassified into IDH-mut/TERTp-mut, IDH-mut only, TERTp-mut only, and IDH-wt/TERTp-wt. 1p/19q co-deletion, TP53-muts, Ki-67 expression differences, and p-MET expression differences characterized IDH-mut/TERTp-mut, IDH-mut only, TERTp-mut only, and IDH-wt/TERTp-wt subtypes, respectively. CONCLUSIONS Our results showed that TERTp-mut combined with IDH-mut allowed simple classification of grade II/III gliomas for stratifying patients and clarifying diagnostic accuracy by supplementing standard histopathological criteria.
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Affiliation(s)
- Pei Yang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Jinquan Cai
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Wei Yan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Wei Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Yinyan Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Baoshi Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Guilin Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Shouwei Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Chenxing Wu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Kun Yao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Wenbin Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Xiaoxia Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Yongping You
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Ling Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Chuanlu Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Xiaoguang Qiu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., X.Q., T.J.); Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (P.Y., W.Z., Y.W., B.C., T.J.); Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China (J.C., C.J.); Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (W.Y., Y.Y.); Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.); Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (S.L., C.W.); Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China (K.Y.); Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (W.L.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University (X.P.); Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (L.C.); Department of Radiation Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.Q.); China National Clinical Research Center for Neurological Diseases (T.J.)
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Abstract
Epilepsy develops in more than 70-90% of oligodendroglial tumors and represents a favorable indicator for long-term survival if present as the first clinical sign. Presence of IDH1 mutation is frequently associated with seizures in oligodendrogliomas, next to alterations of glutamate and GABA metabolism in the origin of glioma-associated epilepsy. Treatment by surgery or radiotherapy results in seizure freedom in about two-thirds of patients, and chemotherapy to a seizure reduction in about 50%. Symptomatic anticonvulsive therapy with levetiracetam and valproic acid as monotherapy are both evidence-based drugs for the partial epilepsies, and their effective use in brain tumors is supported by a large amount of additional data. Pharmacoresistance against anticonvulsants is more prevalent among oligodendrogliomas, occurring in about 40% despite polytherapy with two anticonvulsants or more. Toxic signs of anticonvulsants in brain tumors involve cognition, bone marrow and skin. Previous neurosurgery, radiation therapy or chemotherapy add to the risks of cognitive dysfunction.
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Affiliation(s)
- Melissa Kerkhof
- Department of Neurology, Medical Center The Hague, The Netherlands
| | - Christa Benit
- Department of Neurology, Medical Center The Hague, The Netherlands
| | | | - Charles J Vecht
- Service Neurologie Mazarin, GH Pitié-Salpêtrière, Paris, France
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Abstract
OPINION STATEMENT Seizures represent a common symptom in low- and high-grade gliomas. Tumor location and histology influence the risk for epilepsy. Some molecular factors (BRAF V 600E mutations in glioneuronal tumors and IDH1/2 mutations in diffuse grade II and III gliomas) are molecular factors that are relevant for diagnosis and prognosis and have been associated with the risk of epilepsy as well. Glutamate plays a central role in epileptogenicity and growth of glial and glioneuronal tumors, based on the release of glutamate from tumor cells that enhances excitotoxicity, and a downregulation of the inhibitory GABAergic pathways. Several potential targets for therapy have been identified, and m-TOR inhibitors have already shown activity. Gross total resection is the strongest predictor of seizure freedom in addition to clinical factors, such as preoperative seizure duration, type, and control with antiepileptic drugs (AEDs). Radiotherapy and chemotherapy with alkylating agents (procarbazine, CCNU, vincristine, temozolomide) are effective in reducing the frequency of seizures in patients with pharmacoresistant epilepsy. Newer AEDs (in particular levetiracetam and lacosamide) seem to be better tolerated than the old AEDs (phenobarbital, phenytoin, carbamazepine), but randomized clinical trials are needed to prove their superiority in terms of efficacy.
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Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126, Torino, Italy,
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Association of IDH1/2 mutation with preoperative seizure in low-grade gliomas: how strong is the evidence? Epilepsy Res 2015; 112:154-5. [PMID: 25769499 DOI: 10.1016/j.eplepsyres.2015.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 02/10/2015] [Accepted: 02/14/2015] [Indexed: 11/22/2022]
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Deficiency of very large G-protein-coupled receptor-1 is a risk factor of tumor-related epilepsy: a whole transcriptome sequencing analysis. J Neurooncol 2014; 121:609-16. [PMID: 25511798 DOI: 10.1007/s11060-014-1674-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/30/2014] [Indexed: 12/11/2022]
Abstract
The majority of patients with low-grade glioma (LGG) experience epileptic seizures as their initial symptom, while the underlying mechanisms of tumor-related seizures are still far from being fully understood. In addition to tumor type and location, genetic changes of LGGs are considered to be influential factors in causing epileptic seizures. Nevertheless, the molecular biomarkers associated with tumor-related epilepsy have rarely been identified. RNA sequence data from 80 patients with histologically confirmed LGG were collected from the Chinese glioma genome atlas database and significant differences in expression levels of 33 genes were found. One of the genes, Very large G-protein-coupled receptor-1 (VLGR1), had been previously associated with seizures. Therefore, we investigated the association between LGG-related epilepsy and VLGR1, which played a role in idiopathic epilepsy. The level of VLGR1 expression was compared between patients with epileptic seizures and those without using the reads per kilobase transcriptome per million method. To evaluate the prognostic role of VLGR1 gene expression, the progression-free survival was determined by the Kaplan-Meier method and a multivariate Cox model. We demonstrated that VLGR1 had a significantly lower expression level in patients with epileptic seizures compared to seizure-free patients (p = 0.003). Furthermore, VLGR1 was highly associated with the presence of seizures in a multivariate statistical model. However, VLGR1 could not serve as an independent prognostic factor to determine progression-free survival of LGG patients. Based on RNA sequence data analysis, our results suggest that low expression of VLGR1 is a significant risk factor of epileptic seizures in patients with LGG.
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The role of the corpus callosum in seizure spread: MRI lesion mapping in oligodendrogliomas. Epilepsy Res 2014; 109:126-33. [PMID: 25524852 DOI: 10.1016/j.eplepsyres.2014.10.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/12/2014] [Accepted: 10/26/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Some patients with oligodendrogliomas have generalized tonic-clonic seizures (GTCS) while others have only partial seizures (PS). We investigated the relationship between tumour localization and seizure generalization using quantitative lesion mapping on magnetic resonance images. METHODS Twenty one patients with histologically proven oligodendrogliomas and GTCS (n=11) or PS (n=10) were studied. Data were acquired on a 3 Tesla MRI System. We performed lesion mapping techniques to compare the spatial distribution of oligodendrogliomas between patient groups, and quantitatively determined the extent to which lesions intersected each probabilistic regions-of-interest, including the cerebral lobes, thalamus, striatum, and genu of the corpus callosum. RESULTS In patients experiencing GTCS, the greatest lesion load was observed in mesial frontal regions, including cortex connected to the genu. In contrast, the greatest lesion load in patients experiencing PS was observed more caudo-laterally in orbitofrontal and temporal lobes, but typically sparing cortex connected to the genu. The number of lesion intersections with genu region of interest was significantly greater in patients experiencing GTCS relative to patients with PS (p=0.03). There were no significant differences between patient groups with respect to lesion intersection with the individual cerebral lobes, thalamus and striatum, or with respect to overall oligodendroglioma size. CONCLUSION Our data suggest that the genu of the corpus callosum may be a major pathway for seizure generalization in patients with oligodendrogliomas.
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Yang P, You G, Zhang W, Wang Y, Wang Y, Yao K, Jiang T. Correlation of preoperative seizures with clinicopathological factors and prognosis in anaplastic gliomas: A report of 198 patients from China. Seizure 2014; 23:844-51. [DOI: 10.1016/j.seizure.2014.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/01/2014] [Accepted: 07/08/2014] [Indexed: 12/18/2022] Open
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Fan X, Wang YY, Zhang CB, You G, Li MY, Wang L, Jiang T. Expression of RINT1 predicts seizure occurrence and outcomes in patients with low-grade gliomas. J Cancer Res Clin Oncol 2014; 141:729-34. [DOI: 10.1007/s00432-014-1827-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
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Cowie CJ, Cunningham MO. Peritumoral epilepsy: relating form and function for surgical success. Epilepsy Behav 2014; 38:53-61. [PMID: 24894847 PMCID: PMC4265733 DOI: 10.1016/j.yebeh.2014.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 10/28/2022]
Abstract
Seizures are a prominent symptom in patients with both primary and secondary brain tumors. Medical management of seizure control in this patient group is problematic as the mechanisms linking tumorigenesis and epileptogenesis are poorly understood. It is possible that several mechanisms contribute to tumor-associated epileptic zone formation. In this review, we discuss key candidates that may be implicated in peritumoral epileptogenesis and, in so doing, hope to highlight areas for future research. Furthermore, we summarize the current role of antiepileptic medications in this type of epilepsy and examine the changes in surgical practice which may lead to improved seizure rates after tumor surgery. Lastly, we speculate on possible future preoperative and intraoperative considerations for improving seizure control after tumor resection.
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Affiliation(s)
- Christopher J.A. Cowie
- Department of Neurosurgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK,Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, UK
| | - Mark O. Cunningham
- Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, UK,Corresponding author at: Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK. Tel.: + 44 191 2088935.
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23
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Wang Y, Qian T, You G, Peng X, Chen C, You Y, Yao K, Wu C, Ma J, Sha Z, Wang S, Jiang T. Localizing seizure-susceptible brain regions associated with low-grade gliomas using voxel-based lesion-symptom mapping. Neuro Oncol 2014; 17:282-8. [PMID: 25031032 DOI: 10.1093/neuonc/nou130] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Patients afflicted with low-grade glioma (LGG) frequently suffer from seizures. The mechanisms of seizure initiation in these patients remain poorly understood. Tumor location has been correlated with seizure initiation. However, these correlative studies relied on dichotomized data analysis based on arbitrary lobe assignments. As a result, the lesion-symptom correlation may be incorrectly interpreted. Here, we present the first study that used a voxel-wise quantitative lesion analysis to investigate the spatial correlation between tumor location and seizure susceptibility. METHODS We collected the medical records and magnetic resonance images of 410 LGG patients. The dataset was divided into a discovery set and a validation set. A voxel-based lesion-symptom correlative analysis was performed to determine whether tumor location was associated with seizure risk and could be related to the specific type of seizure. RESULTS For all seizure types, increased seizure risks were identified for LGGs that involved the left premotor area. The LGGs that involved the posterior portion of the left inferior and middle frontal gyrus were associated with increased risk of simple partial seizures. LGGs that involved the right temporal-insular region were associated with an increased risk of complex partial seizures. LGGs that involved the left premotor area were more likely to be associated with seizures that generalize. These correlations were consistently observed in both the discovery and the validation datasets. CONCLUSIONS Our quantitative neuroimaging analyses support the concept that the anatomic location of an LGG is a contributing factor in tumor-related seizure.
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Affiliation(s)
- Yinyan Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Tianyi Qian
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Gan You
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Xiaoxia Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Clark Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Yongping You
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Kun Yao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Chenxing Wu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Jun Ma
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Zhiyi Sha
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Sonya Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Y.W., T.J.); Department of Neurosurgery (Y.W., G.Y., T.J.); Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.M.); Siemens Healthcare, MR Collaboration NE Asia, Beijing, China (T.Q.); Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China (X.P.); Department of Neurosurgery (C.C.); Department of Pediatric Neurology, University of California, San Diego, California (S.W.); Department of Neurosurgery, Nanjing Medical University, The First Affiliated Hospital, Nanjing, China (Y.Y.); Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China (K.Y., C.W.); Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota (Z.S.)
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Pallud J, Audureau E, Blonski M, Sanai N, Bauchet L, Fontaine D, Mandonnet E, Dezamis E, Psimaras D, Guyotat J, Peruzzi P, Page P, Gal B, Párraga E, Baron MH, Vlaicu M, Guillevin R, Devaux B, Duffau H, Taillandier L, Capelle L, Huberfeld G. Epileptic seizures in diffuse low-grade gliomas in adults. ACTA ACUST UNITED AC 2013; 137:449-62. [PMID: 24374407 DOI: 10.1093/brain/awt345] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diffuse low-grade gliomas are highly epileptogenic brain tumours. We aimed to explore the natural course of epileptic seizures, their predictors and the prognostic significance of their occurrence in adult patients harbouring a diffuse low-grade glioma. An observational retrospective multicentre study examined 1509 patients with diffuse low-grade gliomas to identify mutual interactions between tumour characteristics, tumour course and epileptic seizures. At diagnosis, 89.9% of patients had epileptic seizures. Male gender (P = 0.003) and tumour location within functional areas (P = 0.001) were independent predictors of a history of epileptic seizures at diagnosis. Tumour volume, growth velocity, cortical location, histopathological subtype or molecular markers did not significantly affect epileptic seizure occurrence probability. Prolonged history of epileptic seizures (P < 0.001), insular location (P = 0.003) and tumour location close to functional areas (P = 0.038) were independent predictors of uncontrolled epileptic seizures at diagnosis. Occurrence of epileptic seizures (P < 0.001), parietal (P = 0.029) and insular (P = 0.002) locations were independent predictors of uncontrolled epileptic seizures after oncological treatment. Patient age (P < 0.001), subtotal (P = 0.007) and total (P < 0.001) resections were independent predictors of total epileptic seizure control after oncological treatment. History of epileptic seizures at diagnosis and total surgical resection were independently associated with increased malignant progression-free (P < 0.001 and P < 0.001) and overall (P < 0.001 and P = 0.016) survivals. Epileptic seizures are independently associated with diffuse low-grade glioma prognosis. Patients diagnosed with epileptic seizures and those with complete and early surgical resections have better oncological outcomes. Early and maximal surgical resection is thus required for diffuse low-grade gliomas, both for oncological and epileptological purposes.
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Affiliation(s)
- Johan Pallud
- 1 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
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25
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The significance of IDH1 mutations in tumor-associated seizure in 60 Chinese patients with low-grade gliomas. ScientificWorldJournal 2013; 2013:403942. [PMID: 24324372 PMCID: PMC3845343 DOI: 10.1155/2013/403942] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/25/2013] [Indexed: 02/05/2023] Open
Abstract
Background. Seizure is a common clinical presentation in patients suffering from primary brain tumors, especially from low-grade gliomas (LGGs). However, the genetic factors of tumor-associated seizure, at present, are still very poorly understood. The aim of this study was to investigate the potential correlation between tumor-associated epilepsy and IDH1 mutations in a Chinese population with LGGs. Materials and Methods. This study reviewed 60 patients with histologically confirmed low-grade gliomas, and the status of IDH1 was detected after the operation at our institution. Univariate and multivariate logistic regression analysis were used to explore the potential risk factors for tumor-related seizures. Results. IDH1 mutation was detected in 46 (76.7%) patients, among which 14 patients had no epilepsies and 32 patients had epilepsies (P = 0.023, chi-square test). Multivariate logistic regression analysis demonstrated that the mutation of IDH1 seems to be the strongest predictor for preoperative seizure (OR, 6.130; 95% CI, 1.523–24.669; P = 0.011). Conclusions. IDH1 mutation was frequently detected in LGGs, and it may result in tumor-related seizures.
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Rudà R, Bello L, Duffau H, Soffietti R. Seizures in low-grade gliomas: natural history, pathogenesis, and outcome after treatments. Neuro Oncol 2013; 14 Suppl 4:iv55-64. [PMID: 23095831 DOI: 10.1093/neuonc/nos199] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Seizures represent a common symptom in low-grade gliomas; when uncontrolled, they significantly contribute to patient morbidity and negatively impact quality of life. Tumor location and histology influence the risk for epilepsy. The pathogenesis of tumor-related epilepsy is multifactorial and may differ among tumor histologies (glioneuronal tumors vs diffuse grade II gliomas). Gross total resection is the strongest predictor of seizure freedom in addition to clinical factors, such as preoperative seizure duration, type, and control with antiepileptic drugs (AEDs). Epilepsy surgery may improve seizure control. Radiotherapy and chemotherapy with alkylating agents (procarbazine + CCNU+ vincristine, temozolomide) are effective in reducing the frequency of seizures in patients with pharmacoresistant epilepsy. Newer AEDs (levetiracetam, topiramate, lacosamide) seem to be better tolerated than the old AEDs (phenobarbital, phenytoin, carbamazepine), but there is lack of evidence regarding their superiority in terms of efficacy.
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Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, University of Turin and San Giovanni Battista Hospital, Turin, Italy.
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27
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Lian K, Engelsen B, Storstein A. [Glioma-associated epilepsy]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1752-6. [PMID: 22929942 DOI: 10.4045/tidsskr.11.0812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Epileptic seizures are a common symptom in patients with primary brain tumours of the glioma type. The paper presents a discussion of epileptogenesis, choice of medication and follow-up of these patients. METHOD The article is based on a search in PubMed and selection of articles based on the authors' discretionary judgement and clinical experience with this patient group. RESULTS Epileptic seizures are a common symptom of glioma, particularly the low-grade types. The background to glioma-associated epilepsy is multifactorial, and the molecular biological characteristics of the tumour probably play a central part in the epileptogenesis. Effective treatment of epileptic seizures is of great importance to the quality of life of the glioma patient. Seizure frequency and the effectiveness of anti-epileptic treatment vary, and some patients require treatment with several anti-epileptic drugs. Surgical and oncological treatment of the tumour will also often reduce the frequency of seizures. CONCLUSION As a general rule, antiepileptics without enzyme-inducing properties and with low protein-binding should be preferred for glioma patients. This will reduce the risk of interactions with chemotherapy or steroid therapy. Patients with brain tumours are particularly vulnerable to the effects on wakefulness, moods and cognition, and this should be borne in mind in the choice of medication and in follow-up. Haematological status should be monitored particularly closely when there is concomitant use of chemotherapy and antiepileptic drugs that may affect the bone marrow function.
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Affiliation(s)
- Kathrine Lian
- Nevrologisk avdeling, Haukeland universitetssykehus, Norway
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You G, Sha Z, Jiang T. The pathogenesis of tumor-related epilepsy and its implications for clinical treatment. Seizure 2012; 21:153-9. [PMID: 22300623 DOI: 10.1016/j.seizure.2011.12.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/28/2011] [Accepted: 12/29/2011] [Indexed: 01/12/2023] Open
Abstract
Approximately 30-50% of patients with brain tumors present with seizures as the initial symptom. Seizures play a very important role in the quality of life, particularly in patients with slow-growing primary brain tumors. Tumor-related seizures are often refractory to antiepileptic treatment. Despite the importance of this subject to the fields of neurology, neurosurgery and neurooncology, the pathogenesis of tumor-related epilepsy remains poorly understood. This review summarizes possible mechanisms underlying the pathogenesis of tumor-related epilepsy, including both tumoral and peri-tumoral aspects. Tumor cells themselves may create intrinsic epileptogenicity, and inadequate homeostasis in the peri-tumoral tissues may lead to seizure susceptibility. Other local changes in electrolytes, perfusion, metabolism, and enzymes could also contribute. It is generally accepted that changes in amino acid neurotransmission are the most important mechanism underlying tumor-related seizures, and changes in extracellular ions also play an important role. Hypoxia, acidosis, and metabolic, immunological, and inflammatory changes may also be involved in the occurrence of seizures. Knowledge of these mechanisms may provide guidance in the search for new strategies for the surgical and medical treatment of tumor-related epilepsy.
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Affiliation(s)
- Gan You
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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You G, Sha ZY, Yan W, Zhang W, Wang YZ, Li SW, Sang L, Wang Z, Li GL, Li SW, Song YJ, Kang CS, Jiang T. Seizure characteristics and outcomes in 508 Chinese adult patients undergoing primary resection of low-grade gliomas: a clinicopathological study. Neuro Oncol 2011; 14:230-41. [PMID: 22187341 DOI: 10.1093/neuonc/nor205] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Seizure is a common presenting manifestation and plays an important role in the clinical presentation and quality of life for patients with low-grade gliomas (LGGs). The authors set out to identify factors that influence preoperative seizure characteristics and postoperative seizure control. Cases involving adult patients who had undergone initial surgery for LGGs in a single institution between 2005 and 2009 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to identify factors associated with preoperative seizures and postoperative seizure control. Of the 508 patients in the series, 350 (68.9%) presented with seizures. Age less than 38 years and cortical involvement of tumor were more likely to be associated with seizures (P = .003 and .001, respectively, multivariate logistic analysis). For the cohort of 350 patients with seizures, Engel classification was used to evaluate 6- and 12-month outcome after surgery: completely seizure free (Engel class I), 65.3% and 62.5%; not seizure free (Engel classes II, III, IV), 34.7% and 37.5%. After multivariate logistic analysis, favorable seizure prognosis was more common in patients with secondary generalized seizure (P = .006) and with calcification on MRI (.031). With respect to treatment-related variables, patients achieved much better seizure control after gross total resection than after subtotal resection (P < .0001). Ki67 was an independent molecular marker predicting poor seizure control in the patients with a history of seizure if overexpressed but was not a predictor for those without preoperative seizures. These factors may provide insight into developing effective treatment strategies aimed at prolonging patients' survival.
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Affiliation(s)
- Gan You
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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You G, Huang L, Yang P, Zhang W, Yan W, Wang Y, Bao Z, Li S, Li S, Li G, Jiang T. Clinical and molecular genetic factors affecting postoperative seizure control of 183 Chinese adult patients with low-grade gliomas. Eur J Neurol 2011; 19:298-306. [DOI: 10.1111/j.1468-1331.2011.03509.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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