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Epilepsy in primary cerebral tumors: The characteristics of epilepsy at the onset (results from the PERNO study – P roject of E milia R omagna R egion on N euro‐ O ncology)
Author(s) -
Michelucci Roberto,
Pasini Elena,
Meletti Stefano,
Fallica Elisa,
Rizzi Romana,
Florindo Irene,
Chiari Annalisa,
Monetti Cinzia,
Cremonini Anna Maria,
Forlivesi Stefano,
Albani Fiorenzo,
Baruzzi Agostino
Publication year - 2013
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12314
Subject(s) - semiology , status epilepticus , epilepsy , medicine , pediatrics , population , disease , psychiatry , environmental health
Summary Purpose To present new information on the semiology and short‐term evolution of seizures associated with primary brain tumors ( PBT s) in a prospective study. Methods This study is a section of the PERNO study – P roject of E milia R omagna R egion on N euro‐ O ncology, the main aim of which is to collect prospectively all cases of PBT s occurring in the E milia‐ R omagna region, northeast I taly (3,983,346 population) from J anuary 2009 to D ecember 2011, to allow epidemiologic, clinical, and biomolecular studies. The epilepsy section of the PERNO study included all the patients who experienced seizures, either as first symptom of the tumor or appearing during the course of the disease. Each patient was interviewed by the referring neurologist with a specific interest in epilepsy. The patients who entered the study were followed up with visits on a quarterly basis. Key Findings We collected 100 cases with full clinical, neuroradiologic, and pathologic data. The majority (79%) had high grade PBT s (glioblastoma in 50 cases), whereas the remaining patients had low‐grade gliomas, mostly localized in the frontal (60%), temporal (38%), and parietal (28%) lobes. Seizures were the first symptom of the tumor in 72 cases. Overall, the initial seizures were tonic–clonic (48%) (without clear initial focal signs in more than half of the patients), focal motor (26%), complex partial (10%), and somatosensitive (8%). The majority of cases (60%) had isolated seizures or a low seizure frequency at the onset of the disease, whereas a high seizure frequency or status epilepticus was observed in 18% and 12% of cases, respectively. Ninety‐two patients underwent surgical removal of the tumor, which was either radical (38%) or partial (53%). Seven patients underwent only cerebral biopsy. In the 72 patients in whom seizures were the first symptom, the mean time to the surgical treatment was 174 days, with a significant difference between high grade (95 days) and low grade (481 days) gliomas. At the time of our first observation, the majority of patients (69%) had already undergone surgical removal, with a mean follow‐up of 3 months after the procedure. Overall, 39 patients (56%) were seizure free after tumor removal. The good outcome did not depend on presurgical seizure frequency or tumor type, although there was a trend for better results with low‐grade PBT s. Significance These data provide evidence that seizures are strictly linked to the tumoral lesion: They are the initial symptom of the tumor, reflect the tumor location and type, are usually resistant to antiepileptic treatment, and may disappear after the treatment of the lesion.