Tumor-related epilepsy and post-surgical outcomes: tertiary hospital experience in Vietnam

Abstract

Seizures have a significant impact on the quality of life of those who suffer. This study aimed to evaluate the variables that influence the incidence of seizures during the perioperative period and effective measures to enhance epilepsy outcomes among individuals undergoing surgical resection of brain tumors. The authors carried out a prospective observational analysis of all patients who experienced seizures before their brain tumor surgery at UMC, HCMC between 2020 and 2022. 54 cases presented with seizures were enrolled for the study, generalized seizure was the most prevalent seizure type (61.1%), followed by focal seizure (29.6%). The majority of patients presented with seizures are those who were diagnosed with glioma. Low-grade gliomas and frontotemporal lobe tumors increase the postoperative risk of seizure. Other predictive factors are a prolonged history of seizure, especially resistant epilepsy and major peritumoral edema. In contrast, gross total resection reduces postoperative seizure incidence. There was correlation between Ki67 proliferation index and seizure incidence in both low-grade and high-grade gliomas. ECoG made insubstantial difference in enhancing the epilepsy surgery outcome. Overall, 88.9% of patients were seizure-free at 6 months of follow-up (Engel Class I), 7.4% were almost seizure-free (Class II), and 3.7% had significant improvement (Class III), figures for 12-month follow-up were 87.0%, 9.3%, and 3.7% respectively. A shorter history of seizure and gross-total resection appear to be associated with a favorable prognosis for seizure control.

Figure 1

Seizure outcome at 6 and 12 months (EC: Engel Class). There was no one experienced a disabling seizure (Engel Class IV).

Figure 2

Preoperative and postoperative ASM usage. Before surgery, 63% of the patients were prescribed ASM, with valproate and levetiracetam were the most frequently used agent. Resistant epilepsy requires multiple ASM, of which Levetiracetam and Valproate were the most common combination. Almost all patients were prescribed ASM postoperatively, and ASM was gradually tapered over the follow-up time. At 12 months of follow-up, 33.3% of patients achieved complete ASM withdrawal.

Figure 3

Predicted probability of developing LGG- and HGG-related seizure by Ki67. Upper chart: there was a positive correlation between Ki67 level in LGG and preoperative refractory epilepsy, postoperative, 6-month and 12-month seizure rate. Lower chart: among HGG, high Ki67 proliferation index was associated with a lower incidence of both preoperative uncontrolled epilepsy and postoperative seizure.

Figure 4

Patient selection flow diagram for final assessment.