KEY TAKEAWAYS
- The study aimed to investigate the prevalence, risk factors, and prognostic significance of epilepsy in patients with PCNSL.
- Researchers noted that epilepsy is common in patients with PCNSL and may indicate disease progression; further investigation is ongoing.
Epilepsy is frequently observed in patients with brain tumors, yet the specific details regarding its prevalence, onset, characteristics, and risk factors in primary CNS lymphoma (PCNSL) remain inadequately understood.
Oumaima Aboubakr and the team aimed to determine the prevalence of epilepsy among patients with PCNSL, identify the associated risk factors, and explore the prognostic implications of seizures within this population.
They performed an inclusive analysis by conducting an observational, retrospective single-center study at a tertiary neuro-oncology center, focusing on immunocompetent patients with PCNSL and no prior history of seizures between 2011 and 2023.
Clinical, imaging, and treatment data were meticulously gathered, alongside the documentation of seizure status throughout the course of PCNSL, and both oncological and seizure outcomes were evaluated. The primary objective was to determine the prevalence of epilepsy among these patients.
Additionally, the study aimed to identify clinical, radiologic, and treatment-related factors associated with the development of epilepsy. Univariate analyses were employed using the χ2 test for categorical variables and the unpaired t-test for continuous variables. Predictors identified in the unadjusted analysis were further examined through backward stepwise logistic regression models to refine the results.
About 330 patients were included in the study, with 157 (47.6%) being male. The median age at diagnosis was 68 years, and the median Karnofsky Performance Status score was 60. A total of 83 (25.2%) patients experienced at least 1 seizure from the initial diagnosis to the last follow-up, with 40 (12.1%) presenting seizures as the onset symptom, 16 (4.8%) during the first line (1L) of treatment, 27 (8.2%) at tumor progression, and 6 (1.8%) while in remission. Focal-aware seizures were the most frequent type, occurring in 43 (51.8%) patients.
Seizure freedom under antiseizure medication was achieved in 97.6% of patients. Cortical contact (odds ratio [OR] 8.6, 95% CI 4.2-15.5, P < 0.001) and a higher proliferation index (OR 5.7, 95% CI 1.3-26.2, P = 0.02) were identified as independent risk factors for epilepsy.
Patients with PCNSL and epilepsy had a significantly shorter progression-free survival (median PFS) 9.6 vs. 14.1 months, adjusted hazard ratio 1.4, 95% CI 1.0-1.9, P = 0.03), though there was not a significantly shorter overall survival (17 vs. 44.1 months, log-rank test, P = 0.09).
The study concluded that epilepsy affects approximately a quarter of patients with PCNSL, with half of these cases occurring at the time of initial presentation. This finding suggests that epilepsy may serve as a potential marker of disease progression.
However, the applicability of these findings may be limited due to the retrospective design and the single-center, tertiary care setting of the study, underscoring the need for further research to validate these observations.
No funding information was provided.
Source: https://pubmed.ncbi.nlm.nih.gov/39116374/
Aboubakr O, Houillier C, Alentorn A, et al. (2024). “Epilepsy in Patients With Primary CNS Lymphoma: Prevalence, Risk Factors, and Prognostic Significance.” Neurology. 2024 Sep 10;103(5):e209748. doi: 10.1212/WNL.0000000000209748. Epub 2024 Aug 8. PMID: 39116374.
