The Related Factors Of Preoperative And Postoperative Epilepsy In Diffuses Low-grade Glioma

ObjectiveTo explore the relationship between the clinical and pathological characteristics of patients with diffuse low-grade gliomas(DLGG)and its effect of surgery,and to analyze the influencing factors of preoperative and postoperative epilepsy in DLGG related epilepsy patients,to provide an effective treatment plan for DLGG patients.Materials and methodsThe clinical data of 76 patients with DLGG admitted to neurosurgery department of the First Affiliated Hospital of Fujian Medical University from January 2015 to December 2018 were analyzed retrospectively.The variables with significant influence on single factor analysis were analyzed by multivariate logistic regression analysis,and the data were analyzed by spass23.0 software.The test level P < 0.05 was statistically significant.ResultsAmong 76 cases of DLGG,49 were male and 27 were female.Thirty-nine patients were under 40 years old and 37 patients were over 40 years old.There were 49 patients in epilepsy group and 27 of them in non-epilepsy group.Forty patients of diffuse astrocytoma with isocitrate dehydrogenase(IDH)mutation,8 patients of diffuse astrocytoma with IDH wild type,26 patients of oligodendroglioma with IDH mutation combined with 1p19 q deletion,and 2 patients of oligodendroglioma with not otherwise specified(NOS)type.There was no significant difference between the two groups in terms of pathological type,IDH mutation,alpha thalassemia/mental retardation syndrome X-linked gene(ATRX)mutation,High level of p53 expression,methylation of O 6-methylguanine-DNA methyltransferase(MGMT)promoter and telomerase reverse transcriptase(TERT)mutation.Age≤40 years old(P = 0.01),blood glucose value≤4.49mmol/L(P = 0.003),Ki67>4%(P = 0.014)were the risk factors of preoperative epilepsy in patients with DLGG.Multivariate logistic regression analysis showed that age≤40 years old(P = 0.001),blood glucose value≤4.49mmol/L(P =0.009),Ki67 >4%(P = 0.005)were the independent risk factors of pre-operative epilepsy in patients with DLGG.After one year follow-up,33 patients(67.3%)had good prognosis(Engel class I)and 16 patients(32.7%)had poor prognosis(Engel class II-IV).There was no significant difference between the two groups in age,sex,tumor location,peritumoral edema,epilepsy course,form of seizure,postoperative chemotherapy,pathological type,IDH mutation,ATRX mutation,Ki67 expression level,p53 high-expression,MGMT promoter methylation status,TERT mutation.Subtotal tumor resection(P = 0.033)and no postoperative radiotherapy(P = 0.003)were the risk factors for poor postoperative epilepsy control in patients with DLGG related epilepsy.Multivariate logistic regression analysis showed that subtotal tumor resection(P = 0.027)and no postoperative radiotherapy(P = 0.004)were independent risk factors for poor postoperative epilepsy control.ConclusionsThe results showed that the incidence of pre-operative epilepsy in patients with diffuse low-grade glioma was 64.4%,and 67.3% of the patients were completely seizure free(Engel class I).Age≤40 years old,blood glucose≤4.49mmol/L,Ki 67>4% were the independent risk factors of seizure.Subtotal tumor resection and no postoperative radiotherapy are the independent risk factors for poor postoperative epilepsy control.For patients with diffuse low-grade gliomas related epilepsy,the blood glucose level should be monitored before operation,the tumor should be completely removed within the maximum safe range and radiotherapy after operation is conducive to the control of epilepsy.