Impact of seizures and antiseizure medication on survival in patients with glioma

Purpose: Seizures are a common presenting symptom among patients with low- and high-grade glioma. However, the impact and inter-relationship between the presence of seizures, anti-seizure medication and survival are unclear. We retrospectively analyzed the incidence of seizures and identified the pattern and relationship of anti-seizure medication on survival in our cohort of patients with glioma. Methods: We evaluated all glioma patients who underwent treatment at the University of Malaya Medical Centre (UMMC) between 2008 to 2020. Demographic and clinical data of seizures and pattern of ASM administration in comparison to overall survival were analyzed. Results: A total of 239 patients were studied, with a minimum of one year clinical follow-up post-treatment. The mean survival for low-grade glioma was 122 months whereas high-grade glioma was 47 months. One-third of our glioma patients (n=72) presented with seizures. All patients with seizures and a further 49.2% of patients without seizures were started on anti-seizure medication preoperatively. Seizure and Levetiracetam (LEV) were significantly associated with OS on univariate analysis. However, only LEV (p=0.019; HR 0.53;95%CI: 0.31-0.90) was significantly associated with OS on multivariate analysis. Once ASM was adjusted for relevant factors and each other, LEV was found to be protective in all grade gliomas (p=0.012; HR 0.50; 95% CI: 0.30-0.86) and specifically high-grade gliomas (p=0.00; HR 0.44; 95% CI: 0.25-0.77). Conclusions: Pre-operative seizures among patients with glioma indicated a better overall prognosis. The administration of ASM, specifically LEV demonstrated a significant survival advantage in our retrospective cohort of patients.