1
|
Mehrotra A, Singh S, Kanjilal S, Pal L, Paliwal VK, Sardhara J, Behari S. Seizure-outcome after surgery of low-grade epilepsy associated neuro-epithelial tumors. J Neurosurg Sci 2023; 67:591-597. [PMID: 33320468 DOI: 10.23736/s0390-5616.20.05144-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most patients with glioneuronal tumors present with seizures. Although several studies have shown that greater extent of resection improves overall patient survival, few studies have focused on postoperative seizure outcome after resection of these tumors. The aim of this study was to characterize seizure control rates in patients undergoing glioneuronal tumor resection and evaluate the association between poor seizure outcome and tumor recurrence or progression. METHODS The study population included patients who had undergone resection of glioneuronal tumors between 2014 and 2019 at our institution. Seizure outcome was assessed using Engel grading. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed. RESULTS Twenty-six patients (N.=16, temporal lobe; N.=6, frontal lobe; N.=4, parietal lobe) with mean seizures duration of 56.9-months, were assessed. Histopathologically, N.=15 dysembryoplastic neurepithelial tumor, N.=7 ganglioglioma and N.=4 Diffuse lepto-meningeal neuroepithelial tumor. There were 2 cases of complex DNET and one case of DLMNT had associated cortical dysplasia. At mean follow-up of 49.7 months, N.=20 Engel 1, N.=4 Engel 2 and N.=2 had Engel 3 outcome. N.=20 underwent gross total excision (N.=18 Engel 1 and N.=2 Engel 2) and N.=6 sub-total excision. Among the 4 patients who needed re-surgery, two were in Engel 2 and another two were in Engel 3. CONCLUSIONS Good seizure-outcome is likely associated with extent of resection. Younger age of patient, less than one-year of seizure duration and absence of generalization of seizure are good prognostic indicators. The best seizure-control can be achieved by early surgical intervention.
Collapse
Affiliation(s)
- Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India -
| | - Suyash Singh
- Department of Neurosurgery All India Institute of Medical Sciences, Raebarely, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Lily Pal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vimal K Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
2
|
Bonosi L, Benigno UE, Musso S, Giardina K, Gerardi RM, Brunasso L, Costanzo R, Paolini F, Buscemi F, Avallone C, Gulino V, Iacopino DG, Maugeri R. The Role of Aquaporins in Epileptogenesis-A Systematic Review. Int J Mol Sci 2023; 24:11923. [PMID: 37569297 PMCID: PMC10418736 DOI: 10.3390/ijms241511923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Aquaporins (AQPs) are a family of membrane proteins involved in the transport of water and ions across cell membranes. AQPs have been shown to be implicated in various physiological and pathological processes in the brain, including water homeostasis, cell migration, and inflammation, among others. Epileptogenesis is a complex and multifactorial process that involves alterations in the structure and function of neuronal networks. Recent evidence suggests that AQPs may also play a role in the pathogenesis of epilepsy. In animal models of epilepsy, AQPs have been shown to be upregulated in regions of the brain that are involved in seizure generation, suggesting that they may contribute to the hyperexcitability of neuronal networks. Moreover, genetic studies have identified mutations in AQP genes associated with an increased risk of developing epilepsy. Our review aims to investigate the role of AQPs in epilepsy and seizure onset from a pathophysiological point of view, pointing out the potential molecular mechanism and their clinical implications.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (L.B.); (U.E.B.); (S.M.); (K.G.); (R.M.G.); (L.B.); (R.C.); (F.P.); (F.B.); (C.A.); (V.G.); (D.G.I.)
| |
Collapse
|
3
|
Mansouri AM, Germann J, Boutet A, Elias GJB, Mithani K, Chow CT, Karmur B, Ibrahim GM, McAndrews MP, Lozano AM, Zadeh G, Valiante TA. Identification of neural networks preferentially engaged by epileptogenic mass lesions through lesion network mapping analysis. Sci Rep 2020; 10:10989. [PMID: 32620922 PMCID: PMC7335039 DOI: 10.1038/s41598-020-67626-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/09/2020] [Indexed: 11/09/2022] Open
Abstract
Lesion network mapping (LNM) has been applied to true lesions (e.g., cerebrovascular lesions in stroke) to identify functionally connected brain networks. No previous studies have utilized LNM for analysis of intra-axial mass lesions. Here, we implemented LNM for identification of potentially vulnerable epileptogenic networks in mass lesions causing medically-refractory epilepsy (MRE). Intra-axial brain lesions were manually segmented in patients with MRE seen at our institution (EL_INST). These lesions were then normalized to standard space and used as seeds in a high-resolution normative resting state functional magnetic resonance imaging template. The resulting connectivity maps were first thresholded (pBonferroni_cor < 0.05) and binarized; the thresholded binarized connectivity maps were subsequently summed to produce overall group connectivity maps, which were compared with established resting-state networks to identify potential networks prone to epileptogenicity. To validate our data, this approach was also applied to an external dataset of epileptogenic lesions identified from the literature (EL_LIT). As an additional exploratory analysis, we also segmented and computed the connectivity of institutional non-epileptogenic lesions (NEL_INST), calculating voxel-wise odds ratios (VORs) to identify voxels more likely to be functionally-connected with EL_INST versus NEL_INST. To ensure connectivity results were not driven by anatomical overlap, the extent of lesion overlap between EL_INST, and EL_LIT and NEL_INST was assessed using the Dice Similarity Coefficient (DSC, lower index ~ less overlap). Twenty-eight patients from our institution were included (EL_INST: 17 patients, 17 lesions, 10 low-grade glioma, 3 cavernoma, 4 focal cortical dysplasia; NEL_INST: 11 patients, 33 lesions, all brain metastases). An additional 23 cases (25 lesions) with similar characteristics to the EL_INST data were identified from the literature (EL_LIT). Despite minimal anatomical overlap of lesions, both EL_INST and EL_LIT showed greatest functional connectivity overlap with structures in the Default Mode Network, Frontoparietal Network, Ventral Attention Network, and the Limbic Network-with percentage volume overlap of 19.5%, 19.1%, 19.1%, and 12.5%, respectively-suggesting them as networks consistently engaged by epileptogenic mass lesions. Our exploratory analysis moreover showed that the mesial frontal lobes, parahippocampal gyrus, and lateral temporal neocortex were at least twice as likely to be functionally connected with the EL_INST compared to the NEL_INST group (i.e. Peak VOR > 2.0); canonical resting-state networks preferentially engaged by EL_INSTs were the Limbic and the Frontoparietal Networks (Mean VOR > 1.5). In this proof of concept study, we demonstrate the feasibility of LNM for intra-axial mass lesions by showing that ELs have discrete functional connections and may preferentially engage in discrete resting-state networks. Thus, the underlying normative neural circuitry may, in part, explain the propensity of particular lesions toward the development of MRE. If prospectively validated, this has ramifications for patient counseling along with both approach and timing of surgery for lesions in locations prone to development of MRE.
Collapse
Affiliation(s)
| | | | - Alexandre Boutet
- University Health Network, Toronto, ON, USA.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, USA
| | | | - Karim Mithani
- Faculty of Medicine, University of Toronto, Toronto, ON, USA
| | | | - Brij Karmur
- Faculty of Medicine, University of Toronto, Toronto, ON, USA
| | - George M Ibrahim
- Program in Neuroscience and Mental Health, Sickkids Research Institute, Toronto, ON, USA.,Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, USA.,Department of Surgery, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, USA
| | - Mary Pat McAndrews
- Department of Neuropsychology, University Health Network, Toronto, ON, USA
| | - Andres M Lozano
- Division of Neurosurgery, University Health Network, Toronto, ON, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, Toronto, ON, USA
| | - Taufik A Valiante
- Division of Neurosurgery, University Health Network, Toronto, ON, USA
| |
Collapse
|
4
|
Ko A, Lee JS. Factors associated with seizure and cognitive outcomes after epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumors in children. Clin Exp Pediatr 2020; 63:171-177. [PMID: 32024326 PMCID: PMC7254172 DOI: 10.3345/kjp.2019.01151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022] Open
Abstract
Low-grade epilepsy-associated neuroepithelial tumors (LEATs) are responsible for drug-resistant chronic focal epilepsy, and are the second-most common reason for epilepsy surgery in children. LEATs are extremely responsive to surgical treatment, and therefore epilepsy surgery should be considered as a treatment option for LEATs. However, the optimal time for surgery remains controversial, and surgeries are often delayed. In this review, we reviewed published article on the factors associated with seizure and cognitive outcomes after epilepsy surgery for LEATs in children to help clinicians in their decision whether to pursue epilepsy surgery for LEATs. The achievement of gross total resection may be the most important prognostic factor for seizure freedom. A shorter duration of epilepsy, a younger age at surgery, and extended resection of temporal lobe tumors have also been suggested as favorable prognostic factors in terms of seizure control. Poor cognitive function in children with LEATs is associated with a longer duration of epilepsy and a younger age at seizure onset.
Collapse
Affiliation(s)
- Ara Ko
- Division of Pediatric Neurology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Epilepsy and aging. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753149 DOI: 10.1016/b978-0-12-804766-8.00025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The intersection of epilepsy and aging has broad, significant implications. Substantial increases in seizures occur both in the elderly population, who are at a higher risk of developing new-onset epilepsy, and in those with chronic epilepsy who become aged. There are notable gaps in our understanding of aging and epilepsy at the basic and practical levels, which have important consequences. We are in the early stages of understanding the complex relationships between epilepsy and other age-related brain diseases such as stroke, dementia, traumatic brain injury (TBI), and cancer. Furthermore, the clinician must recognize that the presentation and treatment of epilepsy in the elderly are different from those of younger populations. Given the developing awareness of the problem and the capabilities of contemporary, multidisciplinary approaches to advance understanding about the biology of aging and epilepsy, it is reasonable to expect that we will unravel some of the intricacies of epilepsy in the elderly; it is also reasonable to expect that these gains will lead to further improvements in our understanding and treatment of epilepsy for all age groups.
Collapse
|
6
|
Hwang K, Joo JD, Kim YH, Han JH, Oh CW, Yun CH, Park SH, Kim CY. Risk factors for preoperative and late postoperative seizures in primary supratentorial meningiomas. Clin Neurol Neurosurg 2019; 180:34-39. [PMID: 30889470 DOI: 10.1016/j.clineuro.2019.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We performed a retrospective study to identify factors associated with preoperative and late postoperative seizures in primary supratentorial meningiomas. PATIENTS AND METHODS Between July 2003 and December 2014, we extracted 303 consecutive patients who underwent primary resection for supratentorial meningiomas at a single institution. Univariate analysis and multivariate logistic regression analysis were performed to determine the associations of seizure occurrence and outcome. RESULTS Forty-nine (16.2%) of the total 303 patients presented with preoperative seizures. The risk factors independently associated with preoperative seizures were vasogenic edema (OR 4.44, p = 0.001), parasagittal or parafalcine location (OR 2.20, p = 0.020), and absence of neurologic deficit (OR 0.30, p = 0.003). Among these patients, 33 (67.3%) were seizure free postoperatively (Engel Class I). Of the 303 patients, we observed late postoperative seizures in 35 (11.6%) patients. The associated risk factors included history of preoperative seizure (OR 3.96, p = 0.002), bigger tumor size (OR 1.04, p = 0.002), and continuation of anti-epileptic drugs (OR 4.74, p = 0.001). We analyzed that meningiomas with a largest diameter of greater than 45.5 mm were 4.2 times more likely to have late postoperative seizures than those with less diameter (HR 4.20, p < 0.001). Ten (28.6%) of the 35 patients with late postoperative seizures experienced poor seizure control. The independently associated predictive factors were high grade meningiomas (WHO Grade II or III) (OR 10.66, p = 0.030) and history of postoperative adjuvant therapy (OR 12.58, p = 0.040). CONCLUSIONS Identifying factors associated with preoperative or late postoperative seizures may help guide treatment strategies, eventually improving the quality of life for patients with meningiomas.
Collapse
Affiliation(s)
- Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea
| | - Jin-Deok Joo
- Department of Neurosurgery, Jeju National University Hospital, Republic of Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, Republic of Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Seong-Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea.
| |
Collapse
|
7
|
Skardelly M, Rother C, Noell S, Behling F, Wuttke TV, Schittenhelm J, Bisdas S, Meisner C, Rona S, Tabatabai G, Roser F, Tatagiba MS. Risk Factors of Preoperative and Early Postoperative Seizures in Patients with Meningioma: A Retrospective Single-Center Cohort Study. World Neurosurg 2017; 97:538-546. [DOI: 10.1016/j.wneu.2016.10.062] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
|
8
|
Lesional cerebellar epilepsy: a review of the evidence. J Neurol 2016; 264:1-10. [PMID: 27260293 DOI: 10.1007/s00415-016-8161-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
Classical teaching in epileptology localizes the origins of focal seizures solely in the cerebral cortex, with only inhibitory effects attributed to subcortical structures. However, electrophysiological and neuroimaging studies over the last decades now provide evidence for an initiation of epileptic seizures within subcortical structures. Intrinsic epileptogenicity of hypothalamic hamartoma has already been established in recognition of subcortical epilepsy, whereas a seizure-generating impact of dysplastic cerebellar lesions remains to be clarified. Herein, we examine the supportive evidence and clinical presentation of cerebellar seizures and review therapy options.
Collapse
|
9
|
de Oliveira Lima GL, Duffau H. Is there a risk of seizures in “preventive” awake surgery for incidental diffuse low-grade gliomas? J Neurosurg 2015; 122:1397-405. [DOI: 10.3171/2014.9.jns141396] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECT
Although a large amount of data supports resection for symptomatic diffuse low-grade glioma (LGG), the therapeutic strategy regarding incidental LGG (ILGG) is still a matter of debate. Indeed, early “preventive” surgery has recently been proposed in asymptomatic patients with LGG, after showing that the extent of resection was larger than in symptomatic patients with LGG. However, the quality of life should be preserved by avoiding both neurological deficit and epilepsy. The aim of this study was to determine the risk of seizures related to such a prophylactic surgical treatment in ILGG.
METHODS
The authors report a prospective series of 21 patients with ILGG who underwent awake surgery with a minimum follow-up of 20 months following resection. Data regarding clinicoradiological features, surgical procedures, and outcomes were collected and analyzed. In particular, the eventual occurrence and type of seizures in the intra- and postoperative periods were studied, as follows: early (< 3 months) and long-term (until last follow-up) periods.
RESULTS
There were no intraoperative seizures in this series. During the early postoperative period, the authors observed only a single episode of partial seizures in a patient with no antiepileptic drug (AED) prophylaxis—all other patients were given antiepileptic treatment following resection. The AEDs were discontinued in all cases, with a mean delay of 8 months after surgery (range 3–24 months). No patient had permanent neurological deficits. All 21 patients returned to an active familial, social, and professional life (working full time in all cases). Total or even “supratotal” resection (the latter meaning that a margin around the tumor visible on FLAIR-weighted MRI was removed) was achieved in 14 cases (67%). In 7 patients (33%) subtotal resection was performed, with a mean residual tumor volume of 1.5 ml (range 1–7 ml). No oncological treatment was administered in the postsurgical period. The mean follow-up after surgery was 49 months (range 20–181 months). Only 2 patients had seizures during the long-term follow-up. Indeed, due to tumor progression after incomplete resection, seizures occurred in 2 cases, 39 and 78 months postsurgery, leading to administration of AEDs and adjuvant treatment. So far, all patients are still alive and enjoy a normal life.
CONCLUSIONS
The risk of inducing seizures is very low in ILGG, and it does not represent an argument against early surgery. These data strongly support the proposal of a screening policy for LGG that will evolve toward a preventive treatment in a more systematic manner.
Collapse
Affiliation(s)
- Guilherme Lucas de Oliveira Lima
- 1Department of Neurosurgery, Onofre Lopes University Hospital, Rio Grande do Norte Federal University, Petrópolis, and
- 2Neurosurgical Section, Hospital do Coração de Natal, Lagoa Nova, Natal/RN Brazil
| | - Hugues Duffau
- 3Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center; and
- 4Institute for Neuroscience of Montpellier, INSERM U1051, Team “Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors,” Saint Eloi Hospital, Montpellier University MedicalCenter, Montpellier, France
| |
Collapse
|
10
|
Prabowo AS, van Scheppingen J, Iyer AM, Anink JJ, Spliet WGM, van Rijen PC, Schouten-van Meeteren AYN, Aronica E. Differential expression and clinical significance of three inflammation-related microRNAs in gangliogliomas. J Neuroinflammation 2015; 12:97. [PMID: 25986346 PMCID: PMC4446114 DOI: 10.1186/s12974-015-0315-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/30/2015] [Indexed: 01/18/2023] Open
Abstract
PURPOSE miR21, miR146, and miR155 represent a trio of microRNAs which has been shown to play a key role in the regulation of immune and inflammatory responses. In the present study, we investigated the differential expression and clinical significance of these three miRNAs in glioneuronal tumors (gangliogliomas, GGs) which are characterized by prominent activation of the innate immune response. METHODS The expression levels of miR21, miR146, and miR155 were evaluated using Taqman PCR in 34 GGs, including 15 cases with sufficient amount of perilesional cortex. Their expression was correlated with the tumor features and the clinical history of epilepsy. In addition, in situ hybridization was used to evaluate their cellular distribution in both tumor and peritumoral cortex. RESULTS Increased expression of miR146a was observed in both tumor and peritumoral cortex compared to control samples. miR146a was detected in both neuronal and astroglial cells. Tumor and peritumoral miR146a expression was negatively correlated with frequency of seizures and the density of activated microglial cells. Neuronal and astroglial expression was observed for both miR21 and miR155 with increased expression of miR21 within the tumor and miR155 in the peritumoral region. Negative correlations were observed between the miRNA levels and the expression of putative targets within the astroglial component of the tumor. CONCLUSION We report a differential regulation of three miRNAs, known to be related to inflammation, in both tumor and peritumoral cortex of patients with GG. Moreover, our findings suggest a functional relationship between miR146a expression and epilepsy, either directly in epileptogenesis or as modulation of seizure activity.
Collapse
Affiliation(s)
- A S Prabowo
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - J van Scheppingen
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - A M Iyer
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - J J Anink
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - W G M Spliet
- Department of Pathology, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - P C van Rijen
- Department of Neurosurgery, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - A Y N Schouten-van Meeteren
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - E Aronica
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,SEIN - Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands. .,Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
11
|
Goonawardena J, Marshman LA, Drummond KJ. Brain tumour-associated status epilepticus. J Clin Neurosci 2015; 22:29-34. [DOI: 10.1016/j.jocn.2014.03.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 01/27/2023]
|
12
|
Giulioni M, Marucci G, Martinoni M, Marliani AF, Toni F, Bartiromo F, Volpi L, Riguzzi P, Bisulli F, Naldi I, Michelucci R, Baruzzi A, Tinuper P, Rubboli G. Epilepsy associated tumors: Review article. World J Clin Cases 2014; 2:623-641. [PMID: 25405186 PMCID: PMC4233414 DOI: 10.12998/wjcc.v2.i11.623] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/31/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
Long-term epilepsy associated tumors (LEAT) represent a well known cause of focal epilepsies. Glioneuronal tumors are the most frequent histological type consisting of a mixture of glial and neuronal elements and most commonly arising in the temporal lobe. Cortical dysplasia or other neuronal migration abnormalities often coexist. Epilepsy associated with LEAT is generally poorly controlled by antiepileptic drugs while, on the other hand, it is high responsive to surgical treatment. However the best management strategy of tumor-related focal epilepsies remains controversial representing a contemporary issues in epilepsy surgery. Temporo-mesial LEAT have a widespread epileptic network with complex epileptogenic mechanisms. By using an epilepsy surgery oriented strategy LEAT may have an excellent seizure outcome therefore surgical treatment should be offered early, irrespective of pharmacoresistance, avoiding both the consequences of uncontrolled seizures as well as the side effects of prolonged pharmacological therapy and the rare risk of malignant transformation.
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Blumcke I, Aronica E, Urbach H, Alexopoulos A, Gonzalez-Martinez JA. A neuropathology-based approach to epilepsy surgery in brain tumors and proposal for a new terminology use for long-term epilepsy-associated brain tumors. Acta Neuropathol 2014; 128:39-54. [PMID: 24858213 PMCID: PMC4059966 DOI: 10.1007/s00401-014-1288-9] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 12/22/2022]
Abstract
Every fourth patient submitted to epilepsy surgery suffers from a brain tumor. Microscopically, these neoplasms present with a wide-ranging spectrum of glial or glio-neuronal tumor subtypes. Gangliogliomas (GG) and dysembryoplastic neuroepithelial tumors (DNTs) are the most frequently recognized entities accounting for 65 % of 1,551 tumors collected at the European Epilepsy Brain Bank (n = 5,842 epilepsy surgery samples). These tumors often present with early seizure onset at a mean age of 16.5 years, with 77 % of neoplasms affecting the temporal lobe. Relapse and malignant progression are rare events in this particular group of brain tumors. Surgical resection should be regarded, therefore, also as important treatment strategy to prevent epilepsy progression as well as seizure- and medication-related comorbidities. The characteristic clinical presentation and broad histopathological spectrum of these highly epileptogenic brain tumors will herein be classified as “long-term epilepsy associated tumors—LEATs”. LEATs differ from most other brain tumors by early onset of spontaneous seizures, and conceptually are regarded as developmental tumors to explain their pleomorphic microscopic appearance and frequent association with Focal Cortical Dysplasia Type IIIb. However, the broad neuropathologic spectrum and lack of reliable histopathological signatures make these tumors difficult to classify using the WHO system of brain tumors. As another consequence from poor agreement in published LEAT series, molecular diagnostic data remain ambiguous. Availability of surgical tissue specimens from patients which have been well characterized during their presurgical evaluation should open the possibility to systematically address the origin and epileptogenicity of LEATs, and will be further discussed herein. As a conclusion, the authors propose a novel A–B–C terminology of epileptogenic brain tumors (“epileptomas”) which hopefully promote the discussion between neuropathologists, neurooncologists and epileptologists. It must be our future mission to achieve international consensus for the clinico-pathological classification of LEATs that would also involve World Health Organization (WHO) and the International League against Epilepsy (ILAE).
Collapse
Affiliation(s)
- Ingmar Blumcke
- Department of Neuropathology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany,
| | | | | | | | | |
Collapse
|
15
|
Aronica E, Crino PB. Epilepsy related to developmental tumors and malformations of cortical development. Neurotherapeutics 2014; 11:251-68. [PMID: 24481729 PMCID: PMC3996119 DOI: 10.1007/s13311-013-0251-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Structural abnormalities of the brain are increasingly recognized in patients with neurodevelopmental delay and intractable focal epilepsies. The access to clinically well-characterized neurosurgical material has provided a unique opportunity to better define the neuropathological, neurochemical, and molecular features of epilepsy-associated focal developmental lesions. These studies help to further understand the epileptogenic mechanisms of these lesions. Neuropathological evaluation of surgical specimens from patients with epilepsy-associated developmental lesions reveals two major pathologies: focal cortical dysplasia and low-grade developmental tumors (glioneuronal tumors). In the last few years there have been major advances in the recognition of a wide spectrum of developmental lesions associated with a intractable epilepsy, including cortical tubers in patients with tuberous sclerosis complex and hemimegalencephaly. As an increasing number of entities are identified, the development of a unified and comprehensive classification represents a great challenge and requires continuous updates. The present article reviews current knowledge of molecular pathogenesis and the pathophysiological mechanisms of epileptogenesis in this group of developmental disorders. Both emerging neuropathological and basic science evidence will be analyzed, highlighting the involvement of different, but often converging, pathogenetic and epileptogenic mechanisms, which may create the basis for new therapeutic strategies in these disorders.
Collapse
Affiliation(s)
- Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands,
| | | |
Collapse
|
16
|
Tandon N, Esquenazi Y. Resection strategies in tumoral epilepsy: is a lesionectomy enough? Epilepsia 2014; 54 Suppl 9:72-8. [PMID: 24328877 DOI: 10.1111/epi.12448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Resection strategies in patients with tumor-related epilepsy vary from lesionectomy to larger epilepsy operations with no consensus on optimal approaches. The objective of this study is to use our prior experience in the management of these patients, to derive optimal strategies for the surgical management of epilepsy related to brain tumors. A prospectively compiled database of epilepsy and tumor patients was used to identify patients who underwent surgical resection of a neoplasm but then developed epilepsy, or who presented with epilepsy and were found to harbor a brain tumor. Seizure frequency, histopathology, type of surgical resection, and outcomes were compiled. Of 235 epilepsy surgery patients and 75 low/intermediate grade glioma surgery patients, 13 (5.5%) and 21 (28%) patients, respectively, had tumoral epilepsy. Twenty-two patients were male and 18 tumors were in the left hemisphere. Tumoral epilepsy occurred predominantly in temporal (50%) and perirolandic (26.5%) locations. The etiology was WHO grade I tumors in 29%, grade II in 35%, and grade III in 33%. In the epilepsy group, following lesionectomy in three and tailored resections in the majority, seizure outcomes were Engel class I in all except one case. In the tumor group, after the initial operation seven additional resections were performed due to seizure recurrence. Outcomes in this group were Engel class 1A in 18 patients and 1B, 1C and IIA in 1 patient each. Drawing upon these data, we propose a classification of the likely reasons of failure in seizure control in patients with tumoral epilepsy. This review reiterates the concept that a complete resection of the lesion is the best approach for dealing with tumors presenting with epilepsy. Overall excellent outcomes can be accomplished following aggressive initial tumor resection, re-resection in the context of recurrence, and epilepsy style operations in selected patients with a longer history of seizures.
Collapse
Affiliation(s)
- Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, Medical School, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | | |
Collapse
|
17
|
Bhalla D, Godet B, Druet-Cabanac M, Preux PM. Etiologies of epilepsy: a comprehensive review. Expert Rev Neurother 2014; 11:861-76. [DOI: 10.1586/ern.11.51] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
18
|
Hubbard JA, Hsu MS, Fiacco TA, Binder DK. Glial cell changes in epilepsy: Overview of the clinical problem and therapeutic opportunities. Neurochem Int 2013; 63:638-51. [DOI: 10.1016/j.neuint.2013.01.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 01/14/2013] [Accepted: 01/18/2013] [Indexed: 12/20/2022]
|
19
|
Ius T, Pauletto G, Isola M, Gregoraci G, Budai R, Lettieri C, Eleopra R, Fadiga L, Skrap M. Surgery for insular low-grade glioma: predictors of postoperative seizure outcome. J Neurosurg 2013; 120:12-23. [PMID: 24236654 DOI: 10.3171/2013.9.jns13728] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although a number of recent studies on the surgical treatment of insular low-grade glioma (LGG) have demonstrated that aggressive resection leads to increased overall patient survival and decreased malignant progression, less attention has been given to the results with respect to tumor-related epilepsy. The aim of this investigation was to evaluate the impact of volumetric, histological, and intraoperative neurophysiological factors on seizure outcome in patients with insular LGG. METHODS The authors evaluated predictors of seizure outcome with special emphasis on both the extent of tumor resection (EOR) and the tumor's infiltrative pattern quantified by computing the difference between the preoperative T2- and T1-weighted MR images (ΔVT2T1) in 52 patients with preoperative drug-resistant epilepsy. RESULTS The 12-month postoperative seizure outcome (Engel class) was as follows: seizure free (Class I), 67.31%; rare seizures (Class II), 7.69%; meaningful seizure improvement (Class III), 15.38%; and no improvement or worsening (Class IV), 9.62%. Poor seizure control was more common in patients with a longer preoperative seizure history (p < 0.002) and higher frequency of seizures (p = 0.008). Better seizure control was achieved in cases with EOR ≥ 90% (p < 0.001) and ΔVT2T1 < 30 cm(3) (p < 0.001). In the final model, ΔVT2T1 proved to be the strongest independent predictor of seizure outcome in insular LGG patients (p < 0.0001). CONCLUSIONS No or little postoperative seizure improvement occurs mainly in cases with a prevalent infiltrative tumor growth pattern, expressed by high ΔVT2T1 values, which consequently reflects a smaller EOR.
Collapse
|
20
|
Yadav BS, Bansal A, Sharma SC, Malhotra P, Ghosh N, Holdhoff M, Shustov A, Chamberlain M, Newton H, Kumethkar P, Raizer JN, Glass J, Morris GJ. A 60-year-old Indian male with altered sensorium and extensive lymphoma of the scalp. Semin Oncol 2013; 40:e9-21. [PMID: 23806503 DOI: 10.1053/j.seminoncol.2013.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Budhi S Yadav
- Department of Medicine, Mount Sinai Hos- pital of Queens, Long Island City, NY 11102, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, University of Turin and San Giovanni Battista Hospital, Turin, Italy.
| | | | | | | |
Collapse
|
22
|
Transcriptomic profiling of human peritumoral neocortex tissues revealed genes possibly involved in tumor-induced epilepsy. PLoS One 2013; 8:e56077. [PMID: 23418513 PMCID: PMC3572021 DOI: 10.1371/journal.pone.0056077] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/09/2013] [Indexed: 12/11/2022] Open
Abstract
The molecular mechanism underlying tumor-induced epileptogenesis is poorly understood. Alterations in the peritumoral microenvironment are believed to play a significant role in inducing epileptogenesis. We hypothesize that the change of gene expression in brain peritumoral tissues may contribute to the increased neuronal excitability and epileptogenesis. To identify the genes possibly involved in tumor-induced epilepsy, a genome-wide gene expression profiling was conducted using Affymetrix HG U133 plus 2.0 arrays and RNAs derived from formalin-fixed paraffin embedded (FFPE) peritumoral cortex tissue slides from 5-seizure vs. 5-non-seizure low grade brain tumor patients. We identified many differentially expressed genes (DEGs). Seven dysregulated genes (i.e., C1QB, CALCRL, CCR1, KAL1, SLC1A2, SSTR1 and TYRO3) were validated by qRT-PCR, which showed a high concordance. Principal Component Analysis (PCA) showed that epilepsy subjects were clustered together tightly (except one sample) and were clearly separated from the non-epilepsy subjects. Molecular functional categorization showed that significant portions of the DEGs functioned as receptor activity, molecular binding including enzyme binding and transcription factor binding. Pathway analysis showed these DEGs were mainly enriched in focal adhesion, ECM-receptor interaction, and cell adhesion molecules pathways. In conclusion, our study showed that dysregulation of gene expression in the peritumoral tissues may be one of the major mechanisms of brain tumor induced-epilepsy. However, due to the small sample size of the present study, further validation study is needed. A deeper characterization on the dysregulated genes involved in brain tumor-induced epilepsy may shed some light on the management of epilepsy due to brain tumors.
Collapse
|
23
|
Fang S, Zhan Y, Xie YF, Shi Q, Dan W. Predictive value of electrocorticography for postoperative epilepsy in patients with supratentorial meningioma. J Clin Neurosci 2012; 20:112-6. [PMID: 23137667 DOI: 10.1016/j.jocn.2012.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/30/2012] [Accepted: 02/04/2012] [Indexed: 11/16/2022]
Abstract
This study examines electrocorticography (ECoG) signals in patients with supratentorial meningioma before and after tumor resection, and discusses its predictive value with regard to postoperative epilepsy. Ninety-one patients with supratentorial meningioma, who presented with seizures, were studied. Patients were followed-up for 2 to 5 years, and the occurrence rate of postoperative epilepsy in each group was compared. Depending on the frequency and amplitude variation in multiple spike waves on ECoG, patients were divided into those with an increase in epileptic discharge (Group A), those with no change (Group B), and those with a reduction in epileptic discharge (Group C). Postoperative seizures was classified as early postoperative seizures (within 1 week of surgery) or late postoperative seizures (> 1 week after surgery). After lesion resection and measurement of ECoG, the 91 patients were divided into Group A (12 patients, 13.19%), Group B (36 patients, 39.56%) and Group C (43 patients, 47.25%). Of these 91 patients, 29 (31.87%) had early postoperative seizures of which seven patients (58.33%) were from Group A, 13 (36.11%) were from Group B and nine (20.93%) were from Group C (χ(2)=6.53, p<0.05). Seventeen patients (18.68%) had late postoperative seizures, of which two patients (16.67%) were from Group A, seven were from Group B (19.44%) and eight were from Group C (18.60%) (χ(2)=0.05, p>0.05). Of the 29 patients with early postoperative seizures, seven (24.14%) also had late postoperative epilepsy. Of the 62 patients who did not experience early postoperative seizures, 10 (16.13%) also had late postoperative epilepsy (χ(2)=0.83, p>0.05). Thus, the change in ECoG before and after resection in patients with supratentorial meningioma has a predictive value for early postoperative seizures.
Collapse
Affiliation(s)
- Sheng Fang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong, Chongqing 400016, China
| | | | | | | | | |
Collapse
|
24
|
Natrella F, Mariottini A, Rocchi R, Miracco C. Supratentorial neurenteric cyst associated with a intraparenchymal subependymoma. BMJ Case Rep 2012; 2012:bcr.01.2012.5566. [PMID: 22891004 DOI: 10.1136/bcr.01.2012.5566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurenteric cyst is a rare developmental lesion that very infrequently is localised supratentorially. Intraparenchymal subependymoma is an even more rare benign tumour. The authors report the case of a 45-year-old gentleman with a background of drug resistant epilepsy. An MRI was performed which showed a left frontal cystic lesion with a solid component. Histopathology confirmed a type C neurenteric cyst associated with an intraparenchymal subependymoma. Following enlargement of the lesion and worsening of symptoms he was referred to our institution for further management. A frontotemporal craniotomy was performed for excision of the lesion but recurrence occurred within 1 year. The lesion was further excised and 19 months post re-excision the patient is seizure free with no evidence of recurrence on MRI.
Collapse
Affiliation(s)
- Francesco Natrella
- Department of Neurology, Neurosurgery and Behavioral Sciences, Section of Neurosurgery, University of Siena, Siena, Italy.
| | | | | | | |
Collapse
|
25
|
Abstract
The term long-term epilepsy associated tumor (LEAT) encompasses lesions identified in patients investigated for long histories (often 2 years or more) of drug-resistant epilepsy. They are generally slowly growing, low grade, cortically based tumors, more often arising in younger age groups and in many cases exhibit neuronal in addition to glial differentiation. Gangliogliomas and dysembryoplastic neuroepithelial tumors predominate in this group. LEATs are further united by cyto-architectural changes that may be present in the adjacent cortex which have some similarities to developmental focal cortical dysplasias (FCD); these are now grouped as FCD type IIIb in the updated International League Against Epilepsy (ILAE) classification. In the majority of cases, surgical treatments are beneficial from both perspectives of managing the seizures and the tumor. However, in a minority, seizures may recur, tumors may show regrowth or recurrence, and rarely undergo anaplastic progression. Predicting and identifying tumors likely to behave less favorably are key objectives of the neuropathologist. With immunohistochemistry and modern molecular pathology, it is becoming increasingly possible to refine diagnostic groups. Despite this, some LEATs remain difficult to classify, particularly tumors with "non-specific" or diffuse growth patterns. Modification of LEAT classification is inevitable with the goal of unifying terminological criteria applied between centers for accurate clinico-pathological-molecular correlative data to emerge. Finally, establishing the epileptogenic components of LEAT, either within the lesion or perilesional cortex, will elucidate the cellular mechanisms of epileptogenesis, which in turn will guide optimal surgical management of these lesions.
Collapse
Affiliation(s)
- Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL, Institute of Neurology, Queen Square, London, UK.
| | | | | |
Collapse
|
26
|
Binder DK, Nagelhus EA, Ottersen OP. Aquaporin-4 and epilepsy. Glia 2012; 60:1203-14. [DOI: 10.1002/glia.22317] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 02/09/2012] [Indexed: 12/17/2022]
|
27
|
Das RR, Artsy E, Hurwitz S, Wen PY, Black P, Golby A, Dworetzky B, Lee JW. Outcomes after discontinuation of antiepileptic drugs after surgery in patients with low grade brain tumors and meningiomas. J Neurooncol 2012; 107:565-70. [DOI: 10.1007/s11060-011-0779-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 11/30/2011] [Indexed: 12/14/2022]
|
28
|
de Groot M, Iyer A, Zurolo E, Anink J, Heimans JJ, Boison D, Reijneveld JC, Aronica E. Overexpression of ADK in human astrocytic tumors and peritumoral tissue is related to tumor-associated epilepsy. Epilepsia 2011; 53:58-66. [PMID: 22092111 DOI: 10.1111/j.1528-1167.2011.03306.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Adenosine kinase (ADK), a largely astrocyte-based metabolic enzyme, regulates adenosine homeostasis in the brain. Overexpression of ADK decreases extracellular adenosine and consequently leads to seizures. We hypothesized that dysfunction in the metabolism of tumor astrocytes is related to changes in ADK expression and that those changes might be associated with the development of epilepsy in patients with tumors. METHODS We compared ADK expression and cellular distribution in surgically removed tumor tissue (n = 45) and peritumoral cortex (n = 20) of patients with glial and glioneuronal tumors to normal control tissue obtained at autopsy (n = 11). In addition, we compared ADK expression in tumor patients with and without epilepsy. To investigate ADK expression, we used immunohistochemistry and Western blot analysis. ADK activity measurement was performed in surgical specimens of astrocytomas World Health Organization (WHO) grade III (n = 3), peritumoral cortex (n = 3), and nonepileptic cortex (n = 3). KEY FINDINGS Immunohistochemistry predominantly showed cytoplasmic labeling in tumors and peritumoral tissue containing infiltrating tumor cells. ADK immunoreactivity was significantly stronger in tumor and peritumoral tissue compared to normal white matter and normal cortex, especially in astrocytoma WHO grade III, as confirmed by Western blot analysis and ADK activity measurements. Importantly, we found a significantly higher expression of ADK in the peritumoral infiltrated tissue of patients with epilepsy than in patients without epilepsy. SIGNIFICANCE These results suggest a dysregulation of ADK in astrocytic brain tumors. Moreover, the upregulation of ADK observed in peritumoral infiltrated tissue of glioma patients with epilepsy supports the role of this enzyme in tumor-associated epilepsy.
Collapse
Affiliation(s)
- Marjolein de Groot
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Zaghloul KA, Schramm J. Surgical management of glioneuronal tumors with drug-resistant epilepsy. Acta Neurochir (Wien) 2011; 153:1551-9. [PMID: 21603887 DOI: 10.1007/s00701-011-1050-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/09/2011] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the options for the surgical management of glioneuronal tumors (GNTs) associated with drug-resistant epilepsy, with an emphasis on the surgical issues involved in addressing the epileptogenic nature of these lesions. We briefly summarize the pathological hallmarks of these lesions in order to outline how these tumors contribute to seizure activity. Understanding the pathophysiology of these lesions is important in discussing the advantages and disadvantages of different surgical strategies. There have been a number of studies that have investigated the utility of different surgical approaches in improving seizure outcome, and we highlight some of these studies in order to shed light on surgical issues related to these tumors.
Collapse
Affiliation(s)
- Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, USA
| | | |
Collapse
|
30
|
Kelly KM, Chung SS. Surgical treatment for refractory epilepsy: review of patient evaluation and surgical options. EPILEPSY RESEARCH AND TREATMENT 2011; 2011:303624. [PMID: 22937231 PMCID: PMC3420605 DOI: 10.1155/2011/303624] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 02/04/2011] [Accepted: 03/22/2011] [Indexed: 11/17/2022]
Abstract
Treatment of epilepsy often imposes an exposure to various antiepileptic drugs and requires long-term commitment and compliance from the patient. Although many new medications are now available for the treatment of epilepsy, approximately 30% of epilepsy patients still experience recurrent seizures and many experience undesirable side effects. Treatment of epilepsy requires a multidisciplinary approach. For those patients with medically refractory seizures, surgical treatment has increased in prevalence as techniques and devices improve. With increased utilization, proper patient selection has become crucial in evaluating appropriateness of surgical intervention. Epilepsy syndromes in which surgery has shown to be effective include mesial temporal sclerosis, cortical dysplasia, many pediatric epilepsy syndromes, and vascular malformations. Monitoring in an epilepsy monitoring unit with continuous scalp or intracranial EEG is an important step in localization of seizure focus. MRI is the standard imaging technique for evaluation of anatomy. However, other imaging studies including SPECT and PET have become more widespread, often offering increased diagnostic value in select situations. In addition, as an alternative or adjunct to surgical resection, implantable devices such as vagus nerve stimulators, deep brain stimulators, and direct brain stimulators could be useful in seizure treatment.
Collapse
Affiliation(s)
- Kristen M. Kelly
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 720, Phoenix, AZ 85013, USA
| | - Steve S. Chung
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 720, Phoenix, AZ 85013, USA
| |
Collapse
|
31
|
Kargiotis O, Markoula S, Kyritsis AP. Epilepsy in the cancer patient. Cancer Chemother Pharmacol 2011; 67:489-501. [PMID: 21305288 DOI: 10.1007/s00280-011-1569-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Epileptic seizures in patients with malignancies usually occur as a consequence of brain metastases from systemic cancer or the presence of a primary brain tumor. Other less-frequent causes include metabolic disorders such as electrolyte abnormalities, hypoglycemia, hypoxia and liver failure, paraneoplastic encephalitis, leptomeningeal carcinomatosis, side effects of certain chemotherapeutic agents, central nervous system infections, and pre-existing epilepsy. METHODS We reviewed all published literature in the English language regarding the use of antiepileptic drugs in patients with cancer. RESULTS In patients with brain metastases or primary brain tumors that had never experienced seizures, prophylactic anticonvulsant treatment is justified only for a period up to 6 months postoperatively after surgical excision of a cerebral tumor, since approximately half of the patients will never develop seizures and the anti-epileptic drugs may cause toxicity and interactions with antineoplastic therapies. For brief prophylaxis, newer antiepileptic drugs such as levetiracetam and oxcarbazepine are superior to older agents like phenytoin. In patients with a malignancy and seizures, certain antiepileptic drugs that express tumor inhibitory properties should be used such as valproic acid and levetiracetam, followed by oxcarbazepine and topiramate that exhibit good tolerance, efficient seizure control and absence of significant interactions with the chemotherapy. CONCLUSIONS Future clinical trials in patients with cancer and epilepsy should focus on combinations of chemotherapeutic interventions with antiepileptic drugs that demonstrate antineoplastic activities.
Collapse
Affiliation(s)
- Odysseas Kargiotis
- Neurosurgical Research Institute, University of Ioannina, Ioannina, Greece.
| | | | | |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW To present an overview of the recent findings in pathophysiology and management of epileptic seizures in patients with brain tumors. RECENT FINDINGS Low-grade gliomas are the most epileptogenic brain tumors. Regarding pathophysiology, the role of peritumoral changes [hypoxia and acidosis, blood-brain barrier (BBB) disruption, increase or decrease of neurotransmitters and receptors] are of increasing importance. Tumor-associated epilepsy and tumor growth could have some common molecular pathways. Total/subtotal surgical resection (with or without epilepsy surgery) allows a seizure control in a high percentage of patients. Radiotherapy and chemotherapy as well have a role. New antiepileptic drugs are promising, both in terms of efficacy and tolerability. The resistance to antiepileptic drugs is still a major problem: new insights into pathogenesis are needed to develop strategies to manipulate the pharmakoresistance. SUMMARY Epileptic seizures in brain tumors have been definitely recognized as one of the major problems in patients with brain tumors, and need specific and multidisciplinary approaches.
Collapse
|
33
|
Juba KM, Weiland D. Seizure management in a complex hospice patient. J Pain Palliat Care Pharmacother 2010; 24:27-32. [PMID: 20345197 DOI: 10.3109/15360280903583107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Antiepileptic medication use in noncancer hospice/palliative care patients is not well defined. The authors report the case of a human immunodeficiency virus (HIV) patient under hospice care with increased seizure frequency. The patient is a 22-year-old female with advanced HIV disease complicated by tonic-clonic seizures, hypoalbuminemia, gastroesophageal reflux disease (GERD), and gastritis. During an admission to the hospice inpatient unit, she developed increasing seizure frequency while receiving oral phenytoin. After collaboration between the clinical pharmacist and the hospice treating physician, they simplified her medication regimen, discontinued the phenytoin, and initiated oral levetiracetam. After these adjustments to her medication regimen, the patient's seizure frequency decreased significantly. This case illustrates the challenges of anticonvulsant use in advanced disease, including drug-drug interactions, impaired pharmacokinetics parameters, and increased risk of adverse effects. The importance of continuously monitoring patients for adverse drug events and assessing patient specific factors to help guide medication selection are also highlighted.
Collapse
|