Pharmacoresistant seizures and IDH mutation in low-grade gliomas Journal Article
| Authors: | Correia, C. E.; Umemura, Y.; Flynn, J. R.; Reiner, A. S.; Avila, E. K. |
| Article Title: | Pharmacoresistant seizures and IDH mutation in low-grade gliomas |
| Abstract: | Background: Many low-grade gliomas (LGG) harbor isocitrate dehydrogenase (IDH) mutations. Although IDH mutation is known to be epileptogenic, the rate of refractory seizures in LGG with IDH mutation vs wild-type had not been previously compared. We therefore compared seizure pharmacoresistance in IDH-mutated and wild-type LGGs. Methods: Single-institution retrospective study of patients with histologic proven LGG, known IDH mutation status, seizures, and ≥2 neurology clinic encounters. Seizure history was followed until histological high-grade transformation or death. Seizures requiring ≥2 changes in anti-epileptic drugs were considered pharmacoresistant. Incidence rates of pharmacoresistant seizures were estimated using competing risks methodology. Results: Of 135 patients, 25 patients (19%) had LGGs classified as IDH wild-type. Of those with IDH mutation, 104 (94.5%) were IDH1 R132H; only 6 were IDH2 R172K. 120 patients (89%) had tumor resection, and 14 (10%) had biopsy. Initial post-surgical management included observation (64%), concurrent chemoradiation (23%), chemotherapy alone (9%), and radiotherapy alone (4%). Seizures became pharmacoresistant in 24 IDH-mutated patients (22%) and in 3 IDH wild-type patients (12%). The 4-year cumulative incidence of intractable seizures was 17.6% (95% CI: 10.6%-25.9%) in IDH-mutated and 11% (95% CI: 1.3%-32.6%) in IDH wild-type LGG (Gray's P-value =. 26). Conclusions: 22% of the IDH-mutated patients developed pharmacoresistant seizures, compared to 12% of the IDH wild-type tumors. The likelihood of developing pharmacoresistant seizures in patients with LGG-related epilepsy is independent to IDH mutation status, however, IDH-mutated tumors were approximately twice as likely to experience LGG-related pharmacoresistant seizures. © 2021 The Author(s). Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. |
| Keywords: | low-grade glioma; 2-hydroxyglutarate; idh mutation; medically refractory seizure; pharmacoresistant epilepsy |
| Journal Title: | Neuro-Oncology Advances |
| Volume: | 3 |
| Issue: | 1 |
| ISSN: | 2632-2498 |
| Publisher: | Oxford University Press |
| Date Published: | 2021-01-01 |
| Start Page: | vdab146 |
| Language: | English |
| DOI: | 10.1093/noajnl/vdab146 |
| PROVIDER: | scopus |
| PMCID: | PMC8557671 |
| PUBMED: | 34729486 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2022 -- Source: Scopus |
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