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Long-term seizure outcomes in adult patients undergoing primary resection of malignant brain astrocytomas
Journal of Neurosurgery, 08/05/09

Chaichana KL et al. – Identification and consideration of factors associated with prolonged seizure control may guide treatment strategies to improve quality of life for pts with malignant astrocytomas.

Methods

Study to determine preoperative seizure characteristics, effects of surgery on seizure control, and factors associated with prolonged seizure control in pts with malignant astrocytomas
Retrospective review of adult pts with primary resection of hemispheric anaplastic astrocytoma (AA) or glioblastoma multiforme (GBM) at Johns Hopkins 1996-2006
Multivariate logistical regression analysis for associations with preoperative seizures
Multivariate proportional hazards regression analyses for associations with prolonged seizure control post-resection

Results

Of 648 pts (505 GBM; 143 AA), 153 (24%) presented with seizures
More commonly associated with preoperative seizures: AA pathology, temporal lobe involvement, and cortical location
Less commonly associated with preoperative seizures: greater age and larger tumor size
Of pts with seizure history, outcome 12 mo after surgery: Engel Class I (seizure free) in 77%, Class II (rare seizures) 12%, Class III (meaningful improvement) 6%, Class IV (no improvement) 5%
Rare postoperative seizures in pts without history of preoperative seizures
Positively associated with prolonged seizure control: increased Karnofsky Performance Scale score
Negatively associated with seizure control: preoperative uncontrolled seizures and parietal lobe involvement
Independently associated with tumor recurrence: seizure recurrence in pts with postoperative seizure control

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