CLINICAL STUDY - PATIENT STUDY Epilepsy in cerebral glioma: timing of appearance and histological correlations Anna Rosati Æ Alessia Tomassini Æ Bianca Pollo Æ Claudia Ambrosi Æ Andreas Schwarz Æ Alessandro Padovani Æ Bruno Bonetti Received: 19 October 2008 / Accepted: 4 January 2009 / Published online: 29 January 2009 Ó Springer Science+Business Media, LLC. 2009 Abstract Purpose A prospective study of patients with glioma was carried out. Special attention was paid to the first seizure, to the histology, and to the efficacy and pro- phylactic role of antiepileptic drugs (AEDs). Prognostic factors were analyzed. Methods Between February 1st 2004 and April 1st 2006 patients who underwent surgical treatment at the Neurosurgery Department of Bolzano for primary or recurrent glioma were prospectively followed until April 1st 2007. Seizures at onset occurring in the absence of interictal epileptiform abnormalities were regarded as remote symptomatic seizures and not treated. Results Sixty-four individuals were registered in the study; epilepsy diagnosis was made in 27 cases and in 24 of these seizures were the onset symptom. The correlation with histological grading showed that seizures were more fre- quent in low-grade glioma and in secondary glioblastoma. Although epilepsy was less frequent in high-grade glioma, in these patients seizures were more difficult to control. Poor seizure control was associated with motor and sen- sitive focal seizures and presence of neurological deficit. Patients without epilepsy and not taking AEDs never developed seizures during the follow-up. Discussion Our study clearly shows that epilepsy is more frequent in low- grade gliomas but seizures are more difficult to control in high-grade gliomas. In both cases seizures are a quite exclusive symptom at the onset that never appears during the stable course of the disease. Amongst glioblastoma multiforme (GBM), epilepsy is more frequent in GBM developing through progression from low-grade astroci- toma. Moreover, our study strongly indicates that the prophylactic use of AEDs in glioma is not justified. Keywords Symptomatic epilepsy Á Brain tumors Á Glioblastoma Á Antiepileptic drug (AED) Á Prophylaxis Introduction Epilepsy diagnosis needs the recurrence of seizures in the absence of provoking factors (unprovoked seizures) or even only a single seizure in the presence of any factor that can predispose to future seizures, for example brain injuries or lesions (remote symptomatic seizure) [1]. Epileptiform abnormalities, remote symptomatic seizures, family history of epilepsy, and abnormal imaging all increase the risk of recurrence and, therefore, the likelihood of treatment after All authors confirm that they have read the Journal’s position on issues involved in ethical publication and affirm that the work is consistent with those guidelines. All authors disclose non conflict of interest. All authors have been substantively involved in the study and/or the preparation of the manuscript. All authors have seen and approved the submitted version of the paper and accept responsibility for its content. A. Rosati (&) Á A. Padovani Neurology Clinic, University of Brescia, Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy e-mail: anna.rosati@libero.it A. Tomassini Á A. Schwarz Division of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy B. Pollo Neuropathology Service, Neurological Institute ‘‘C. Besta’’, Milan, Italy C. Ambrosi Neuroradiology Service, University of Brescia, Brescia, Italy B. Bonetti Ospedale Policlinico GB Rossi, Department of Neurological Sciences and Vision, University of Verona, P. Scuro 10, 37134 Verona, Italy 123 J Neurooncol (2009) 93:395–400 DOI 10.1007/s11060-009-9796-5