Tumor-related epilepsy and preoperative cognitive performance in glioma: a preliminary study.

Abstract

Purpose: Tumor-related epilepsy (TRE) is also associated with younger age, less aggressive tumor characteristics, and isocitrate dehydrogenase (IDH)-mutant gliomas, all of which may influence cognition. We examined whether preoperative cognitive performance differed according to seizure presentation after accounting for demographic and tumor-related factors.

Methods: Sixty-five treatment-naïve patients with newly diagnosed glioma were included (TRE, n = 30; non-TRE, n = 35). Neuropsychological performance was expressed as demographically adjusted percentile ranks. Group differences were examined using Mann-Whitney U tests with Benjamini-Hochberg false discovery rate correction. Multivariable regression examined whether the association between seizure presentation and cognition persisted after adjustment for age and enhancing tumor volume. Sensitivity analyses additionally incorporated IDH status and other demographic and clinicopathological variables.

Results: Patients with TRE were younger more educated, had smaller enhancing tumor volumes, lower-grade tumors, and more frequent IDH mutations. Although several cognitive measures favored the TRE group, only Trail Making Test Part A remained significant after correction (median percentile, 83 vs. 21; q = 0.04; r = .41). In multivariable analysis, seizure presentation remained significantly associated with better TMT-A performance after adjustment for age and enhancing tumor volume (B = 0.276, p = .017). The association remained significant in the sensitivity model incorporating IDH status and additional clinicopathological characteristics.

Conclusion: Seizure presentation was associated with better preoperative TMT-A performance after adjustment for selected demographic and tumor-burden factors. The persistence of this association across sensitivity analyses suggests that TRE may capture clinically relevant aspects of the tumor-brain context that are not fully reflected by conventional demographic, pathological, and molecular characteristics.