RESUMEN
BACKGROUND: Little information is available regarding the effect of conventional radiotherapy on glioma-related seizures. METHODS: In this retrospective study, we analyzed the seizure response and outcome following conventional radiotherapy in a cohort of 43 patients with glioma (33 grade II, 10 grade III) and medically intractable epilepsy. RESULTS: At 3 months after radiotherapy, seizure reduction was significant (≥ 50% reduction of frequency compared with baseline) in 31/43 patients (72%) of the whole series and in 25/33 patients (76%) with grade II gliomas, whereas at 12 months seizure reduction was significant in 26/34 (76%) and in 19/25 (76%) patients, respectively. Seizure reduction was observed more often among patients displaying an objective tumor response on MRI, but patients with no change on MRI also had a significant seizure reduction. Seizure freedom (Engel class I) was achieved at 12 months in 32% of all patients and in 38% of patients with grade II tumors. Timing of radiotherapy and duration of seizures prior to radiotherapy were significantly associated with seizure reduction. CONCLUSIONS: This study showed that a high proportion of patients with medically intractable epilepsy from diffuse gliomas derive a significant and durable benefit from radiotherapy in terms of epilepsy control and that this positive effect is not strictly associated with tumor shrinkage as shown on MRI. Radiotherapy at tumor progression seems as effective as early radiotherapy after surgery. Prospective studies must confirm and better characterize the response to radiotherapy.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Glioma/complicaciones , Radioterapia , Convulsiones/prevención & control , Adulto , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/terapia , Femenino , Estudios de Seguimiento , Glioma/patología , Glioma/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Estudios Retrospectivos , Convulsiones/etiología , Convulsiones/radioterapia , Adulto JovenRESUMEN
PURPOSE: To analyze the topography of the epileptogenic zone (EZ) and the etiologic substrate as risk factors for sleep-related focal epilepsy. METHODS: Three hundred three patients (172 males and 131 females, mean age at surgery 25.6 +/- 13.1 years), who were seizure-free after resective surgery for drug-resistant focal epilepsy, were retrospectively reviewed. Statistical analysis was conducted to evaluate the risk of presenting sleep-related epilepsy (SRE) against topography of resection (assumed to correspond or to include the EZ) and results of histology. RESULTS: Thirty-nine patients (12.8%) presented with an SRE. At bivariate analysis, a higher frequency of SRE was associated with a frontal lobe EZ (p = 1.94 x 10(-9)) and Taylor's FCD (TFCD, p = 2.20 x 10(-16)), whereas architectural FCD (p = 0.00977), ganglioglioma (p = 0.02508), and mesial temporal sclerosis (p = 2.47 x 10(-5)) were correlated with a reduced frequency of SRE. Multivariate analysis demonstrated that the only variable significantly associated with SRE was the presence of a TFCD, which increased 14-fold the risk of SRE [p = 1.66 x 10(-10); risk ratio (RR) = 14.44]. DISCUSSION: In this study, we have demonstrated a significant and strong association between SRE and TFCD in a select population of patients with drug-resistant focal epilepsy submitted to surgical resection of the EZ. Although our results cannot be applied to the entire spectrum of SRE, the presence of TFCD as the underlying etiology should be considered when evaluating patients with SRE, because surgery can provide excellent results on seizures in these cases.
Asunto(s)
Corteza Cerebral/patología , Epilepsias Parciales/epidemiología , Malformaciones del Desarrollo Cortical/epidemiología , Malformaciones del Desarrollo Cortical/patología , Trastornos del Sueño del Ritmo Circadiano/epidemiología , Adulto , Mapeo Encefálico , Corteza Cerebral/cirugía , Comorbilidad , Supervivencia sin Enfermedad , Resistencia a Medicamentos , Electroencefalografía/métodos , Electroencefalografía/estadística & datos numéricos , Epilepsias Parciales/tratamiento farmacológico , Epilepsias Parciales/cirugía , Epilepsia del Lóbulo Frontal/diagnóstico , Epilepsia del Lóbulo Frontal/epidemiología , Epilepsia del Lóbulo Frontal/patología , Epilepsia del Lóbulo Temporal/diagnóstico , Epilepsia del Lóbulo Temporal/epidemiología , Epilepsia del Lóbulo Temporal/patología , Femenino , Humanos , Masculino , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Esclerosis/patología , Trastornos del Sueño del Ritmo Circadiano/patologíaRESUMEN
PURPOSE: Individuals with epilepsy commonly report daytime sleepiness, attributed to sleep disruption (frequent arousals, awakenings, and stage shifts) induced by ictal and interictal activity or antiepileptic drugs (AEDs) or both. To study the effect of levetiracetam (LEV) on sleep, at full doses but without the interference of epilepsy, we investigated the sleep architecture and daytime vigilance in healthy adults after 3 weeks of treatment. METHODS: The study was of a double-blind crossover design with random allocation of multiple doses of two different treatments (randomly first LEV Asunto(s)
Anticonvulsivantes/farmacología
, Nivel de Alerta/efectos de los fármacos
, Piracetam/análogos & derivados
, Sueño/efectos de los fármacos
, Adulto
, Anticonvulsivantes/efectos adversos
, Anticonvulsivantes/uso terapéutico
, Estudios Cruzados
, Relación Dosis-Respuesta a Droga
, Método Doble Ciego
, Esquema de Medicación
, Epilepsia/tratamiento farmacológico
, Epilepsia/psicología
, Femenino
, Humanos
, Levetiracetam
, Masculino
, Piracetam/farmacología
, Piracetam/uso terapéutico
, Placebos
, Polisomnografía/efectos de los fármacos
, Trastornos del Sueño-Vigilia/inducido químicamente
, Trastornos del Sueño-Vigilia/psicología
, Resultado del Tratamiento