دانلود رایگان مقاله انگلیسی نوسانات فرکانس بالا در بیماران بیدار تحت جراحی صرع مربوط به تومور مغزی - NCBI 2018

Abstract

Objective To examine the relationship between high-frequency oscillations (HFOs) and the presence of preoperative seizures, World Health Organization tumor grade, and isocitrate dehydrogenase 1 (IDH1) mutational status in gliomas. Methods We retrospectively studied intraoperative electrocorticography recorded in 16 patients with brain tumor (12 presenting with seizures) who underwent awake craniotomy and surgical resection between September 2016 and June 2017. The number and distribution of HFOs were determined and quantified visually and with an automated HFO detector. Results Five patients had low-grade (1 with grade I and 4 with grade II) and 11 had high-grade (6 with grade III and 5 with grade IV) brain tumors. An IDH1 mutation was found in 6 patients. Patients with a history of preoperative seizures were more likely to have HFOs than those without preoperative seizures (9 of 12 vs 0 of 4, p = 0.02). The rate of HFOs was higher in patients with IDH1 mutant (mean 7.2 per minute) than IDH wild-type (mean 2.3 per minute) genotype (p = 0.03). Conclusions HFOs are common in brain tumor-related epilepsy, and HFO rate may be a useful measure of epileptogenicity in gliomas. Our findings further support the notion that IDH1 mutant genotype is more epileptogenic than IDH1 wild-type genotype gliomas. Glossary AED = antiepileptic drug; BTRE = brain tumor-related epilepsy; ECoG = electrocorticography; GBM = glioblastoma multiforme; HFO = high-frequency oscillation; IDH1 = isocitrate dehydrogenase 1; WHO = World Health Organization.

Discussion

This study examined the intraoperative ECoG in 16 patients with brain tumor who underwent awake craniotomy and surgical resection. This study demonstrated that HFOs can be safely and reliably recorded with high-density grid, strips, or depth electrodes during awake craniotomy in patients with BTRE. We also found that HFOs are prevalent in BTRE and that the rate of HFOs was higher in patients with IDH1mut than in those with IDH1wt. In this cohort, 12 of 16 (75%) patients presented with seizures as an initial manifestation of brain tumor. Five of 6 patients with the IDH1mut genotype presented with seizures as an initial manifestation. This finding is similar to the recent observation that patients whose tumors expressed IDH1mut were more likely to have experienced seizures at diagnosis than patients with IDH1wt. 5,6 The overproduction of D-2- hydroxyglutarate with its structural similarity to glutamate may play a role in the mechanism of neuronal excitation leading to seizures.7,8 In our cohort, the rate of preoperative seizures did not differ by IDH1 mutation status. This finding is not surprising because there is a possibility that other tumor markers, including p53 overexpression, may have played a role in generating seizures in addition to the activation of glutamate receptors in patients with IDH1wt. 3 The latter could suggest that tumor-specific pathophysiologic mechanisms might be involved in the generation of seizure.