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Tumor Rapid Fire Abstract

Tumor

Factors Associated With Pre- and Postoperative Seizures in Patients with IDH Wildtype Glioma

Sunday, May 5, 2024
2:35 PM – 2:37 PM CT
Location:  S405a
Disclosure(s):
Joseph H. Garcia, MD: No financial relationships to disclose
Introduction: Epileptic seizures are a common and potentially devastating complication for patients with IDH1 wildtype glioma. Although prior studies have examined GBM related seizures, there is a paucity of clinically relevant studies which examine seizures in relation to clinical, morphologic, and molecular factors which predispose these brain tumor patients to greater risk of epileptic seizures.

Methods: Patients who underwent resection of a grade IV glioma at UPMC were retrospectively reviewed. Patients included in the study were ≥18 years of age, required surgical resection, and were treated at UPMC. Demographic, clinical, and morphologic variables were collected using retrospective chart review. Patients were evaluated for pathological grading, IDH1 status, and seizure occurrence preoperatively and postoperatively. Logistic and linear regression analyses were used to assess the association of variables of interest with and preoperative and postoperative seizures.

Results: Data were retrospectively analyzed for 1299 consecutive patients with surgically treated high-grade gliomas operated on between 2009 and 2019. The cohort had a mean age of 63.6 years and was 59% female. Overall, 212 patients with GBMs experienced epileptic seizures prior to operation. Post-operatively, 217 patients experienced seizures. By univariate analysis, frontal lobe location (p=0.05), temporal lobe location (p=0.02), hypertension (p=0.03), and limbic system involvement (p=0.02) were associated with seizure presentation. Postoperative Avastin use (p=0.004), temozolomide use (p= 0.006), postoperative infection (p=0.008), and postoperative radiation therapy (p=0.006) were associated with seizures post-op; while older age (p=0.002) was associated with fewer seizures (p=0.007). A final multivariate model confirmed an independent effect of frontal and temporal lobe tumor location and hypertension as predictors of preoperative seizures, and Avastin use and postoperative infection as predictors of seizures at six months postoperatively.

Conclusion : Within this cohort of patients with IDH1 wildtype glioma, seizures were seen in almost a quarter of patients pre- and postoperatively. Frontal and temporal tumors and hypertension are associated with a higher risk of preoperative seizures while avastin use, and postoperative infection appear to be associated with seizures at six months after surgery.