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Impact of seizures and antiseizure medication on survival in patients with glioma

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Abstract

Purpose

Seizures are a common presenting symptom among patients with low- and high-grade glioma. However, the impact and inter-relationship between the presence of seizures, anti-seizure medication (ASM) and survival are unclear. We retrospectively analyzed the incidence of seizures and identified the pattern and relationship of anti-seizure medication on survival in our cohort of patients with glioma.

Methods

We evaluated all glioma patients who underwent treatment at the University of Malaya Medical Centre (UMMC) between 2008 and 2020. Demographic and clinical data of seizures and pattern of ASM administration in comparison to overall survival were analyzed.

Results

A total of 235 patients were studied, with a minimum of one year clinical follow-up post-treatment. The median survival for low-grade glioma was 38 months whereas high-grade glioma was 15 months. One-third of our glioma patients (n = 74) presented with seizures. All patients with seizures and a further 31% of patients without seizures were started on anti-seizure medication preoperatively. Seizure and Levetiracetam (LEV) were significantly associated with OS on univariate analysis. However, only LEV (HR 0.49; 95% CI 0.23-0.87; p=0.02) was significantly associated with improving overall survival (OS) on multivariate analysis. Once ASM was adjusted for relevant factors and each other, LEV was associated with improved survival in all grade gliomas (HR 0.52; 95% CI 0.31-0.88; p=0.02) and specifically high-grade gliomas (HR 0.53; 95% CI 0.30-0.94; p=0.03).

Conclusions

Pre-operative seizures among patients with glioma indicated a better overall prognosis. The administration of ASM, specifically LEV was associated with a  significant survival advantage in our retrospective cohort of patients.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This study is sponsored by an Impact-oriented Interdisciplinary Research Grant (IIRG) (reference no: IIRG003-2020HWB).

Funding

This work was supported by Impact-oriented Interdisciplinary Research Grant (IIRG) (reference no: IIRG003-2020HWB).

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Thinisha Sathis Kumar & Vairavan Narayanan

  2. Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Wan Muhammad Afnan, Chet-Ying Chan, Christine Audrey, Si-Lei Fong & Kheng-Seang Lim

  3. Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Retnagowri Rajandram

  4. Hospital Tanah Merah Kelantan, Tanah Merah, Malaysia

    Thinisha Sathis Kumar, Wan Muhammad Afnan, Chet-Ying Chan, Christine Audrey, Si-Lei Fong, Retnagowri Rajandram, Kheng-Seang Lim & Vairavan Narayanan

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  1. Thinisha Sathis Kumar
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Contributions

Conception and design of original study was by VN; Material preparation, data collection and analysis were performed by TS, WMA, Vanessa, CA, SLF, and RR. The first draft of manuscript was written by TSK. Approval of final manuscript was done by KSLand VN.

Corresponding author

Correspondence to Vairavan Narayanan.

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The authors have no relevant financial or non-financial interest to disclose.

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Ethical approval was obtained from the Medical Research Ethics Committee, UMMC (No. 2020930-9118).

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Informed consent was not required as this was a retrospective anonymous design study.

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Kumar, T.S., Afnan, W.M., Chan, CY. et al. Impact of seizures and antiseizure medication on survival in patients with glioma. J Neurooncol 159, 657–664 (2022). https://doi.org/10.1007/s11060-022-04108-2

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