Epilepsy and Low-Grade Diffuse Gliomas: Epidemiological, Imaging, and Clinical Impact Analysis

• Grant number: 25/00458-4
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: April 01, 2025
• End date: March 31, 2026
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Enrico Ghizoni
• Grantee: Leticia Bragalia Passarella
• Host Institution: Faculdade de Ciências Médicas (FCM). Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil

Abstract

IntroductionLow-grade diffuse gliomas (LGGs) in adults are rare primary central nervous system tumors classified as grade II by the WHO. Primarily located in the cerebral hemispheres, they include astrocytomas and oligodendrogliomas. Although they exhibit slower progression and better prognosis compared to high-grade tumors, LGGs are strongly associated with epilepsy, with seizures often being the first symptom. This relationship highlights the need to investigate the clinical characteristics and prognostic factors of these tumors.JustificationResearch on the relationship between LGGs and epilepsy aims to evaluate how surgical resection impacts clinical outcomes, including seizure control. Surgical intervention has proven effective, particularly in patients with refractory epilepsy, contributing to improved quality of life and reducing the risk of malignant transformation.ObjectivesGeneral Objective: Investigate the clinical outcomes of patients with LGGs undergoing surgical resection, focusing on seizure control.Specific Objectives:Analyze the frequency and characteristics of seizures in LGG patients before and after resection.Evaluate the impact of the extent of surgical resection on long-term seizure control.Identify prognostic factors such as tumor location and IDH mutation status.Explore the role of advanced imaging techniques in tumor delineation and prognosis.Materials and MethodsContextualization of LGGsLGGs exhibit diffuse infiltration and predominantly affect young adults. The incidence rate is 11.3 cases per 100,000 people per year. Favorable prognostic factors include young age, good functional performance, total tumor resection, and small preoperative tumor volume. Management includes corticosteroids for edema and anticonvulsants for seizures.Epileptogenicity in LGGsEpilepsy occurs in 60% to 85% of cases, with seizures being the first symptom in 70% to 90%. Surgical resection is an effective approach for refractory seizures, with more than 80% of patients achieving complete seizure control post-surgery. Epileptogenic mechanisms include structural alterations, such as neuronal loss and reactive astrogliosis, and genetic factors, like the IDH mutation, which promotes neuronal hyperexcitability. Tumor location, particularly in the temporal lobe, is associated with frequent and complex seizures.Clinical Impacts and the Role of SurgerySurgical resection is crucial for seizure control and improving quality of life. Studies indicate that the extent of resection is the primary predictor of postoperative seizure control. In complete resections, over 80% of patients achieve total seizure control.ConclusionEpilepsy associated with LGGs profoundly impacts patients' quality of life, making seizure control essential. Extensive surgical resection is the recommended approach, especially in refractory cases. This study aims to address gaps in the literature by exploring clinical characteristics, prognostic factors, and the role of imaging techniques in managing LGG patients.