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Forum Name: Neurology Topics

Question: low grade glioma


 fonzy - Sun Aug 01, 2010 7:54 am

Hello. I have a mid brain low grade tumor, situated more to the left frontal lobe. For 20 years I have suffered probably a grand mal seizure every 2-3 years, really infrequently and I hav had no more than ten in total. Over the last 2 years I have had 5 seizures with 2 in the last 6 months. These seem to be becoming more frequent and severe in nature. It has been 2 weeks since last one and I am still feeling the after effects. As well as this my general health is detiorating as my symptoms are getting worse. How frequently will seizures occur with a tumor? And doea my past seizure history indicate maybe a pattern of growth? I.e. Do the seizures happen when tumor grows? Many thanks
 Dr.M.Aroon kamath - Sat Aug 14, 2010 10:57 pm

User avatar Hi,
Low-grade gliomas (LGGs) are a heterogeneous group of relatively slow-growing primary tumors (astrocytic and/or oligodendroglial). Peak incidence is seen in the second and third decade of life.

Infiltrating low-grade astrocytomas tend to occur in the cerebral hemispheres, especially in the frontal lobe. Many patients will present with seizures that are easily controlled and will remain stable for many years. However, some may progress rapidly, with increasing neurological symptoms, to a higher-grade tumor.This behavior of some of these tumors can't be predicted at initial presentation based on their morphology. The time interval to progression also varies considerably from a few months to several years.

The prevalent treatment options have been limited to
- surgery whenever feasible, and
- radiotherapy and palliative chemotherapy at recurrence.

A subtype, oligodendroglioma with specific molecular changes (allelic loss on chromosomes 1p and 19q) has been recognized fairly recently to be a distinct subgroup with a better prognosis and exhibiting a particular sensitivity to chemotherapy. A newer chemotheraputic agent, temozolomide, a novel alkylating agent, has been approved for the treatment of recurrent malignant (high-grade) gliomas.

European Organization for Research and Treatment of Cancer (EORTC) prognostic score for identifying patients with the worst prognosis who are most likely to benefit from therapy: Age ≥40 years, tumor size >6 cm, astrocytic tumor type, tumor crossing the midline and neurological deficit at diagnosis were identified as independent prognostic factors, and the presence of three or more of these factors was seen to be associated with an unfavorable prognosis.

Low grade glioma with epilepsy as the single symptom has been noted to have a much better prognosis than if accompanied by other symptoms. The prognosis does not appear to be influenced by the timing of surgery. It appears,that it may be safer to wait until clinical or radiological progression, before considering surgery in this subset.

As you seem to belong to the subset with epilepsy as the only symptom, you need to consult your neurosurgeon, who will be able to decide based on neurologic examination and possibly a repeat MRI, whether your tumor is clinically or radiologically stable or otherwise. This will likely decide on the further management.
Best wishes!

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