Clinical characteristics associated with the development of preoperative and postoperative seizures in patients with glioblastoma
Sofía Sánchez Boluarte1, Diogo P. Moniz Garcia2, Charlene Gunasekera2, William Tatum2, Joseph Sirven2, Brin Freund2, Anthony Ritaccio2, Kaisorn Chaichana2, Alfredo Quiñones-Hinojosa2, Anteneh Feyissa2
1Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, 2Mayo Clinic
Objective:
To determine the factors which predict the occurrence of preoperative seizures (PRS) and post-operative seizures (POS) among patients with glioblastoma (GBM).
Background:
Seizures have been well described in patients with GBM, albeit at a lower frequency than low grade gliomas. Although recent studies suggest epileptogenesis has more to do with genetic molecular markers in low grade glioma-related seizure, information on factors that influence the development of of GBM-related PRS and POS is lacking.
Design/Methods:
We performed a single-center retrospective cohort study of patients with GBM evaluated at Mayo Clinic Florida, between 2018 and 2022. Clinical factors including, tumor molecular markers, neurophysiological and imaging findings were analyzed according to the status of PRS and POS.
Results:
One hundred thirty-two adult patients (median age=61.5 years), 79 (59.85%) females) were included. The most common locations were the temporal (n=50, 42.02%) and frontal (n=47, 39.50%) lobes. All patients underwent GBM resection, with 17.1% undergoing total resection (n=22). Sixty-two patients (46.27%) underwent intra-operative electrocorticography during GBM resection. Isocitrate dehydrogenase 1 (IDH1) wildtype was present in 121 patients (90.3%), 61 patients had O6-methylguanine-DNA methyltransferase (MGMT)-methylated GBM (46.21%). Forty patients (33.9%) had PRS, and 39 patients (38.24%) had POS (median follow-up=17.27 months; IQR=10.6–30.1). IDH1 wildtype and MGMT methylation status were not associated with PRS or POS. Patients with PRS were younger (59 years vs. 64 years, p=0.021) and experienced a longer survival time (16.1 months vs. 8.3 months, p=0.044) compared to patients without PRS. Occipital lobe GBM was associated with a lower likelihood of PRS (p=0.043) and POS (p=0.001).
Conclusions:
PRS is associated with younger age and longer survival time. PRS and POS are less likely to occur with occipital lobe tumors. Further studies are needed to confirm our findings and elucidate the influence of other tumor molecular markers in the development of PRS and POS in patients with GBM.