Robust and Specific Association Between Seizure at Presentation and Improved Survival in Patients With Primary Brain Tumors.

Abstract

Background: Whether seizure presentation in patients afflicted with primary brain tumors (PBT) is associated with clinical prognosis remains an open question. We explore this association using the Nationwide Readmission Database (NRD).

Methods: A systematic literature review was conducted to summarize prior studies focusing on the association between the presence of seizure and outcomes of PBT/brain metastases (BM). The statistical power of the study was defined as a function of the effect size. We identified 50,380 and 32,789 PBT and BM patients in the NRD (2010-2018), respectively. Multivariable logistic regression models were utilized to assess the risk of mortality and the related factors.

Results: In a multivariable model accounting for known survival pertinent variables (age, gender, insurance status, income, hospital length of stay, discharge disposition, hospital features), the adjusted odds ratio (aOR) of death for PBT patients who presented with seizures and underwent craniotomy was 0.67 [95% Confidence Interval (CI): 0.52-0.86, p = 0.002] relative to those presented without seizures. The aOR of death for PBT patients who presented with seizures and underwent biopsy was 0.55 (95% CI: 0.30-1.00, p = 0.048) relative to those without seizures. This association was not observed for BM patients; the aOR of death for BMs who presented with seizures was 0.91 (p = 0.483) and 0.32 (p = 0.090) relative to those presented without seizures for craniotomy and biopsy patients, respectively. A comprehensive review of the literature showed that the predominance of the available studies supported the reported association.

Conclusions: We report an association between seizure at presentation and decreased mortality risk for PBT patients. The association was robust in both patients who underwent craniotomy as well as stereotactic needle biopsy but was not observed in BM patients.