Original Paper
Prevalence and prognostic significance of epilepsy in patients with gliomas

https://doi.org/10.1016/S0959-8049(97)00374-2Get rights and content

Abstract

The aim of this study was to evaluate the prevalence and prognostic significance of epilepsy in 1028 patients diagnosed in the computer tomography (CT) era with histological low- or high-grade intracranial gliomas. Survival analysis included Kaplan–Meier plots, log-rank tests, logistic regression and Cox’s analysis as implemented in the SPSS statistical package. Epilepsy was a positive univariate (P < 0.0001) and multivariate, (P < 0.03) prognostic factor for survival in the total patient group (n = 1028, relative risk of death 0.83, 95% confidence interval (CI) 0.70–0.98) as well as in the high-grade patient group (n = 649, relative risk of death 0.80, 95% CI 0.66–0.96), but not in the group of low-grade glioma patients (P > 0.2). The prevalence of epilepsy in glioblastoma patients was 251/512 (49%), 95/137 (69%) in anaplastic gliomas, and 322/379 (85%) in patients with low-grade gliomas, with 97 of the 102 T1 low-grade subgroup (95%) having epilepsy, indicating that the presence of epilepsy may select patients for early radiological diagnosis. The frequency of epilepsy at presentation decreased with age in high-grade glioma patients, and increased with age in low-grade glioma patients to a plateau in the fourth decade of life (P < 0.01). The prevalence of epilepsy in patients with histological intracranial gliomas varied with patient age and tumour histology, with low-grade patients having the highest prevalence. Epilepsy was a significant positive prognostic factor except in patients with low-grade gliomas, and may select low-grade patients for early diagnosis.

Introduction

Epileptic seizures are common in patients with primary brain tumours1, 2, 3, and those who present with seizures may have a better prognosis4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. A prevalence of epilepsy in a larger series of high-grade gliomas ranging from 22 to 37% has been reported4, 5, 6. In previous reports of astrocytomas or low-grade gliomas, the prevalence of epilepsy has ranged from 50 to 78%7, 8, 9, 10, 11. An exceptionally high value of 90% in patients with astrocytoma was found in Piepmeier’s study[12]. Oligodendroglioma patients are generally thought to have the highest probability of epilepsy, with a prevalence of 72% in two recent series13, 14. However, most published papers reporting the prevalence and prognostic significance of epilepsy in patients with intracranial gliomas are fairly small2, 6, 8, 9, 10, 11, 12, report on selected patients4, 5, 9, 12, 14, 16, accrued before the computer tomography (CT) era2, 9, 13, 17, or include many patients with unknown histology7, 15. Such studies may not reliably describe the true prevalence and prognostic implications of epilepsy in patients with gliomas.

Therefore, we investigated the prevalence and prognostic implications of epilepsy in 1028 consecutive patients with intracranial gliomas of known histology accrued at a single regional centre during the CT era.

Section snippets

Patients and methods

Data from 1028 patients with histologically verified primary intracranial tumours seen at the Norwegian Radium Hospital between 1980 and 1995 were examined. Together with two regional neurosurgical departments, the hospital provides the only neuro-oncological service to a population of 1.6 million living in south-eastern Norway outside Oslo. Between 1980 and 1987, the hospital also provided radiotherapy for brain tumour patients from the five northernmost counties of Norway.

Hospital records were

Results

Median patient age and survival in each main histological subgroup are presented in Table 2. Only 61 patients were younger than 20 years, 20 had high-grade and 41 had low-grade tumours. A total of 190 patients, 170 with high-grade and 20 with low-grade tumours, were over 60 years of age. WHO performance status was 0–1 in 807 patients and 2–4 in 220 patients with histological intracranial glioma. Overall, 669 out of these 1028 patients (65.1%) experienced epileptic seizures during their

Discussion

The reported prevalence of epilepsy in patients with gliomas ranges from 30 to 90%4, 5, 6, 7, 8, 12, 13, 14, 15, 17, 22, 23, with low-grade glioma patients having the highest prevalence7, 8, 9, 11, 12, 22. In an unselected patient group containing high-grade aggressive tumours as well as indolent low-grade gliomas, epilepsy clearly can be expected to be a positive prognostic factor7, 16, 17, 23.

Our findings, based on a very large single institution regionally and consecutively accrued patient

Acknowledgements

Knut Lote was a Clinical Research Fellow for the Norwegian Cancer Society.

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