Epileptic seizures heralding a relapse in high grade gliomas.
PURPOSE
Seizures are a common clinical symptom in high-grade gliomas (HGG). The aim of the study was to investigate the relationship between seizures and HGG relapse (HGG-R).


METHODS
We retrospectively evaluated 145 patients who were surgically treated for HGG-R. By analyzing clinical characteristics in these patients (all operated and treated by the same protocol), we identified 37 patients with seizures during follow-up. This cohort was divided into four subgroups according to a) presence or absence of seizures at the time of diagnosis and b) temporal relationship between seizure occurrence and HGG-R during follow-up: subgroup A (25pts) had seizures at follow-up but not at onset, subgroup B (12pts) had seizures both at follow-up and onset, subgroup C (30pts) had seizures before MRI-documented HGG-R, and subgroup D (7pts) had seizures after MRI-documented HGG-R.


RESULTS
Although the datum was not statistically significant, survival was longer in patients with seizures during follow-up than in those without seizures (59.3% vs 51.4% alive at 2 years). In 30 patients (subgroup C) seizures heralded HGG-R. In a correlation analysis for this last subgroup, the time interval between seizure and the HGG-R was significantly associated with the number of chemotherapy cycles (r=0.470; p=0.009) and follow-up duration (r=0.566; p=0.001). A linear regression model demonstrated a reciprocal association between the above factors and that it may be possible to estimate the timing of HGG-R by combining these data.


CONCLUSIONS
Seizures may herald HGG-R before MRI detection of relapse, thus suggesting that seizures should always be considered a red flag during follow-up.
['Di Bonaventura|Carlo|C|', 'Albini|Mariarita|M|', "D'Elia|Alessandro|A|", 'Fattouch|Jinane|J|', 'Fanella|Martina|M|', 'Morano|Alessandra|A|', 'Lucignani|Giulia|G|', 'Manfredi|Mario|M|', 'Colonnese|Claudio|C|', 'Salvati|Maurizio|M|', 'Vanacore|Nicola|N|', 'Berardelli|Alfredo|A|', 'Giallonardo|Anna Teresa|AT|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001932:Brain Neoplasms D015331:Cohort Studies D004827:Epilepsy D005260:Female D005910:Glioma D006801:Humans D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D012189:Retrospective Studies D012640:Seizures D055815:Young Adult
Seizures Relapse High grade glioma Epilepsy