Seizure Management in Glioma Patients

Seizures represent a frequent and debilitating comorbidity in patients with glioma, occurring in up to 90% of low-grade and 50% of high-grade cases. These events arise from tumour-induced alterations in cortical excitability, involving direct neuronal firing, peritumoral oedema and neurotransmitter imbalances. Management demands a multimodal approach: first-line treatment with anti-seizure medications (ASMs) selected for favourable pharmacokinetics and minimal interactions with chemoradiation; surgical resection aiming for maximal extent while preserving neurological function; and adjuvant therapies targeting molecular drivers of tumour growth and hyperexcitability. Radiotherapy and systemic chemotherapy can also modulate seizure susceptibility, with agents such as temozolomide occasionally yielding reduction in seizure frequency that may precede radiological tumour shrinkage. Emerging evidence highlights the importance of molecular stratification, notably isocitrate dehydrogenase (IDH) mutations, in predicting seizure risk and guiding targeted interventions. Advanced imaging and electrophysiological monitoring facilitate individualised mapping of epileptogenic zones, while novel biomarkers derived from multi-omics profiling may refine prognostication. In refractory cases, neuromodulation and dietary interventions are under investigation. Quality-of-life considerations and rehabilitation are integral to long-term care, emphasising patient-centred decision-making in a multidisciplinary setting.

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Seizure Management in Glioma Patients publication trend

The graph below shows the total number of articles in seizure management in glioma patients across all publications each year (not limited to Nature Index journals).

Technical terms

Glioma: A type of primary brain tumour arising from glial cells, classified by histology and molecular features.

Epileptogenesis: The process by which a normal brain develops recurrent seizures following injury or in the presence of a tumour.

Anti-seizure medication (ASM): A pharmacological agent used to prevent or reduce the occurrence of epileptic seizures.

IDH mutation: A genetic alteration in isocitrate dehydrogenase enzymes that influences tumour metabolism and seizure propensity.

Multi-omics: An integrative approach combining genomics, transcriptomics, proteomics and metabolomics to elucidate disease mechanisms.

References

1. IDH-mutated gliomas promote epileptogenesis through d-2-hydroxyglutarate-dependent mTOR hyperactivation. Neuro-Oncology (2022).
2. Postoperative risk of IDH mutant glioma-associated seizures and their potential management with IDH mutant inhibitors. Journal of Clinical Investigation (2023).
3. Multi‐omics technologies and molecular biomarkers in brain tumor‐related epilepsy. CNS Neuroscience & Therapeutics (2024).
4. Clinical practice guidelines for the diagnosis and treatment of adult diffuse glioma‐related epilepsy. Cancer Medicine (2019).
5. Glioma-related seizures in relation to histopathological subtypes: a report from the glioma international case–control study. Journal of Neurology (2018).
6. Seizure reduction is a prognostic marker in low-grade glioma patients treated with temozolomide. Journal of Neuro-Oncology (2015).