Outcomes of epilepsy surgery in patients with diffuse gliomas of the brain

Abstract

   The objectives of surgical treatment of patients with diff use brain gliomas include achieving control over epileptic seizures and improving quality of life, in addition to prolonging relapse-free period and life duration.   The aim of the research is to study the factors that determine the eff ectiveness of epilepsy surgery in patients with diffuse brain gliomas.   Material and methods. The study group comprised 104 patients with diff use brain gliomas, aged 41.21 ± 14.74. Results of author’s research. Clinical, neuroimaging and morphological factors were studied. Of the studied group of 104 patients with diffuse brain gliomas who had been diagnosed with epilepsy prior to surgery, the remission of 6 months after surgery was achieved in 58 (55.77 %) patients and of 12 months in 55 (52.88 %) patients. The development of acute symptomatic epileptic seizures (p = 0.68067) and acute symptomatic status epilepticus (p = 0.41626) in post-operative period do not determine the outcomes of epilepsy surgery. Neither the histological subtype of the diffuse brain gliomas, nor the molecular-genetic factor (IDH1/2 mutation, 1p/19q codeletion) determines the outcomes of epilepsy surgery in this patient category. The group of antiepileptic medications or the medication regimen (monotherapy, two-drug therapy) also does not determine the surgery outcomes. The factors that determine a favorable outcome of surgical treatment for epilepsy in patients with diff use brain gliomas are complete tumor removal and involvement of brain commissures after magnetic resonance imaging before surgery.   Conclusion. The effectiveness of epilepsy surgery is determined by the radical removal of the diff use brain glioma, thereby eliminating the glutamate-mediated mechanisms of epileptogenesis.