Seizure characteristics and control following resection in 332 patients with low-grade gliomas
Seizure characteristics and control following resection in 332 patients with low-grade gliomas
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DOI：
10.3171/jns/2008/108/2/0227
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发表时间：
2008-02-01
影响因子：
4.1
通讯作者：
Berger, Mitchel S.
中科院分区：
文献类型：
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作者：
Chang, Edward F.;Potts, Matthew B.;Berger, Mitchel S.
对象。癫痫发作在手术切除低级别胶质瘤（LGGs）患者的临床表现和术后生活质量中起着重要作用。本研究的目的是确定影响围手术期癫痫发作特征和术后癫痫发作控制的因素。作者对1997年至2003年间在加州大学旧金山分校接受lgg初始手术的所有成年患者进行了回顾性图表回顾。纳入332例病例进行分析；332例患者中有269例（81%）出现>= 1癫痫发作（全面性发作33%，复杂部分发作16%，单纯性部分发作22%，合并发作29%）。皮质部位、少突胶质细胞瘤和少星形细胞瘤亚型与癫痫发作的相关性分别高于中线部位和星形细胞瘤（p分别= 0.017和0.001；多因素分析）。269例癫痫发作患者中，132例（49%）术前有耐药癫痫发作。在这些患者中，癫痫发作更可能是单纯性部分发作和累及颞叶，并且从癫痫发作到手术的时间可能更长（p分别= 0.0005、0.0089和0.006；多变量分析）。对于出现癫痫发作的患者队列，手术后12个月的结局（Engel级）如下：无癫痫发作(I), 67%；罕见发作（II）， 17%；有意义的癫痫发作改善（III）， 8%；无改善或恶化（IV）， 9%。发作史较长（p = 0.001）和单纯性部分性发作（p = 0.004）的患者发作控制较差。对于治疗相关的变量，总的全切除比单独的次全切除/活检更容易控制癫痫发作（优势比16,95%可信区间2.2-124,p = 0.0064）。术后初始癫痫控制后癫痫复发与肿瘤进展相关（p = 0.001）。大多数LGG患者出现癫痫发作；在这些患者中，大约有一半的患者在手术前癫痫发作是耐药的。术后，90%的患者无癫痫发作或有明显改善。较短的癫痫发作史和全切除似乎与癫痫发作控制的良好预后有关。
Object. Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control.Methods. The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003.Results. Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with >= 1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively (p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before Surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer (p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history (p = 0.001) and simple partial seizures (p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after Subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2-124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression (p = 0.001).Conclusions. The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.