Post-operative Seizure Status Among Patients Operated for Brain Tumor with Seizure- Multicenter Retrospective Cross-sectional Study
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Date
2020-12
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Addis Abeba University
Abstract
Background: Seizure is one of common presentations of brain tumor. Surgical resection is
useful in controlling seizures and in eradicating the symptoms associated with compression.
Objective: The aim of this research was to examine postoperative seizure status and factors
significantly associated with postoperative seizure control following brain tumor surgery in
patients with brain tumor and seizure.
Methods: Multicenter retrospective cross-sectional study was conducted among 97 patients
with brain tumor and seizure who had undergone initial surgery at three selected teaching
hospitals in central Ethiopia from January 1, 2015 to December 31, 2019. Assessment of
postsurgical seizure status were described using Engel’s classification of seizure: completely
seizure free (Engel class I), and not seizure free (Engel classes II, III, IV). Demographic, seizure
history, radiographic characteristics, histopathologic diagnosis, treatment, preoperative and
postoperative antiepileptic drug use data were collected and analyzed for statistical association
with postoperative seizure control using univariate and multivariate logistic regression analyses.
P- Values of less than 0.05 and confidence level of 95% were considered to indicate statistical
significance and strength of association respectively.
Results: Ninety seven patients (60 females, 37 males) were included, with a mean age of 41.7
years and a median seizure duration of 8 months. There were generalized tonic-clonic seizures in
52 patients (53.6%).The histopathology confirmed meningioma in 71.1% (n = 69) of patients,
low grade glioma in 12.4% (n = 12), and high grade glioma in 11.3% (n = 11) of patients. Gross
total resection was achieved in 80.4% (n = 78) of patients and subtotal resection in 19.6% (n =
19) of patients. During a median follow-up of 6 months (range 3 months to 3 years), 66% of
patients were seizure free (Engel’s Class I). Seizure freedom was predicted by gross total
resection (adjusted OR 6.24, 95% CI: 1.79-21.71, P=0.004) and seizure duration ≤ 1 year before
surgery (adjusted OR 3.60, 95% CI: 1.20-10.82, P=0.022) on multivariate analysis. Occurrence
of postoperative weakness after surgery (adjusted OR 16.23, 95% CI: 2.57-103.09, P=0.003) and
uncontrolled preoperative seizure (adjusted OR 4.69, 95% CI: 1.49-14.75, P=0.008) were found
to be significant independent predictors associated with uncontrolled postoperative seizure
status.
Conclusions: Sixty six percent of brain tumor patients in this study were seizure-free
following surgery. Specific variables that were strongly associated with seizure-free outcome
included gross total resection and seizure duration ≤ 1 year prior to surgery. These findings
suggest that strict preoperative seizure control, early surgical intervention, and complete tumor
resection increases the chance of postoperative seizure control.
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Keywords
Brain Tumor ,Seizure- Multicenter , Patients