Glioma-related epilepsy following low-grade glioma surgery

Epileptic seizures commonly burden low-grade glioma (LGG) patients and negatively impact quality of life, neurocognition and general patient health. Anti-seizure medications (ASM) are used to manage seizures, but can result in undesired side effects. Our aim was to report our experience in epilepsy in one of the largest case series of LGG patients (re-classified in accordance with the WHO 2021 classification). Furthermore, we evaluate our post-operative seizure frequency difference between LGG patients that use pre-operative ASMs and ones with no ASMs. Data was retrospectively collected from Salford Royal Hospital electronic records and Neuro-oncology database from 2006 until 2022. Descriptive statistics were performed for demographic analysis, while multivariable analysis was used to determine post-operative seizure-free outcomes. In total, 257 operations were performed on 206 patients. Post-operatively, 114 patients suffered with seizures and approximately 45.2% of patients developed seizures at 3-12 months post-surgery, with the odds higher in patients on pre-operative ASMs. There was no evidence to suggest a higher post-operative seizure rate in patients undergoing awake craniotomy versus general anaesthetic. The extent of resection (EOR) was inversely related to seizure failure, with gross-total resection showing a statistically significant reduction in seizures in comparison to all other surgical resections. In our experience, there is no evidence to suggest a reduced post-operative seizure outcome when prescribing pre-operative ASMs. EOR is an independent prognosticator for post-operative seizure failure with all other variables demonstrating non-significance. Overall, a larger study can investigate the role of ASMs in LGG in greater detail.