Epilepsy in Primary Cerebral Tumors: Long-Term Follow-Up of Seizures in the PERNO Study (Project of Emilia Romagna Region on Neuro-Oncology)

Objective: Despite the high prevalence of epilepsy in brain tumors, long-term follow-up studies on tumoral epilepsy are lacking. Here we report the long-term follow-up results of the PERNO study (Project of Emilia-Romagna Region on Neuro-Oncology). Methods: PERNO study enrolled for a three-year period every person living in Emilia-Romagna Region with a new diagnosis of primary brain tumor (PBT). We previously described the short-term results of epilepsy evolution after the first surgical procedure in 100 patients; for 52 patients of this group, the long-term results of seizure outcome after a mean follow-up of 24 months are now available. Results: Out of these 52 patients, 41 presented with a high-grade glioma (HGG), whereas 11 had a low-grade glioma (LGG) at the onset of the disease (HGG/LGG ratio = 3.7) and were followed-up for a median period of 548 and 1032 days, respectively. The HGG group showed a seizure-freedom rate of more than 60%, with a better seizure control (up to 87%) being achieved in patients without evidence of tumor progression. Conversely, in the LGG group complete seizure control occurred only in one case (less than 10% of patients), with most patients requiring surgical revision due to the extension of the tumor. Conclusions: Our data show that epilepsy associated with HGG seems to have a relatively good outcome, especially if the tumor is stable. In contrast, seizure control in LGG was more difficult to be achieved, suggesting the need of detailed epileptological study (including long-term video-EEG monitoring) before surgery to improve seizure control.