Pharmacoresistant seizures and IDH mutation in low-grade gliomas

Authors

Carlos Eduardo Correia, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Yoshie Umemura, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Jessica R. Flynn, Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Anne S. Reiner, Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Edward K. Avila, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Document Type

Article

Abstract

BACKGROUND: Many low-grade gliomas (LGG) harbor isocitrate dehydrogenase (IDH) mutations. Although mutation is known to be epileptogenic, the rate of refractory seizures in LGG with mutation vs wild-type had not been previously compared. We therefore compared seizure pharmacoresistance in -mutated and wild-type LGGs. METHODS: Single-institution retrospective study of patients with histologic proven LGG, known 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 wild-type. Of those with mutation, 104 (94.5%) were R132H; only 6 were 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 -mutated patients (22%) and in 3 wild-type patients (12%). The 4-year cumulative incidence of intractable seizures was 17.6% (95% CI: 10.6%-25.9%) in -mutated and 11% (95% CI: 1.3%-32.6%) in wild-type LGG (Gray's -value = .26). CONCLUSIONS: 22% of the -mutated patients developed pharmacoresistant seizures, compared to 12% of the wild-type tumors. The likelihood of developing pharmacoresistant seizures in patients with LGG-related epilepsy is independent to mutation status, however, -mutated tumors were approximately twice as likely to experience LGG-related pharmacoresistant seizures.

Publication Date

1-1-2021

Publication Title

Neuro-oncology advances

E-ISSN

2632-2498

Volume

3

Issue

1

First Page

vdab146

PubMed ID

34729486

Digital Object Identifier (DOI)

10.1093/noajnl/vdab146

Recommended Citation

Correia, Carlos Eduardo; Umemura, Yoshie; Flynn, Jessica R.; Reiner, Anne S.; and Avila, Edward K., "Pharmacoresistant seizures and IDH mutation in low-grade gliomas" (2021). Neurology. 1455.
https://scholar.barrowneuro.org/neurology/1455