Post-operative Seizure Status Among Patients Operated For Brain Tumor With Seizure- Multicenter Retrospective Cross-sectional Study

Background: Seizure is one of common presentations of brain tumor. Surgical resection is rnuseful in controlling seizures and in eradicating the symptoms associated with compression. rnObjective: The aim of this research was to examine postoperative seizure status and factorsrnsignificantly associated with postoperative seizure control following brain tumor surgery in rnpatients with brain tumor and seizure. rnMethods: Multicenter retrospective cross-sectional study was conducted among 97 patientsrnwith brain tumor and seizure who had undergone initial surgery at three selected teaching rnhospitals in central Ethiopia from January 1, 2015 to December 31, 2019. Assessment ofrnpostsurgical seizure status were described using Engel’s classification of seizure: completelyrnseizure free (Engel class I), and not seizure free (Engel classes II, III, IV). Demographic, seizurernhistory, radiographic characteristics, histopathologic diagnosis, treatment, preoperative andrnpostoperative antiepileptic drug use data were collected and analyzed for statistical associationrnwith postoperative seizure control using univariate and multivariate logistic regression analyses.rnP- Values of less than 0.05 and confidence level of 95% were considered to indicate statisticalrnsignificance and strength of association respectively. rnResults: Ninety seven patients (60 females, 37 males) were included, with a mean age of 41.7rnyears and a median seizure duration of 8 months. There were generalized tonic-clonic seizures inrn52 patients (53.6%).The histopathology confirmed meningioma in 71.1% (n = 69) of patients, rnlow grade glioma in 12.4% (n = 12), and high grade glioma in 11.3% (n = 11) of patients. Grossrntotal resection was achieved in 80.4% (n = 78) of patients and subtotal resection in 19.6% (n =rn19) of patients. During a median follow-up of 6 months (range 3 months to 3 years), 66% ofrnpatients were seizure free (Engel’s Class I). Seizure freedom was predicted by gross totalrnresection (adjusted OR 6.24, 95% CI: 1.79-21.71, P=0.004) and seizure duration ≤ 1 year beforernsurgery (adjusted OR 3.60, 95% CI: 1.20-10.82, P=0.022) on multivariate analysis. Occurrencernof postoperative weakness after surgery (adjusted OR 16.23, 95% CI: 2.57-103.09, P=0.003) andrnuncontrolled preoperative seizure (adjusted OR 4.69, 95% CI: 1.49-14.75, P=0.008) were foundrnto be significant independent predictors associated with uncontrolled postoperative seizurernstatus. rnConclusions: Sixty six percent of brain tumor patients in this study were seizure-freernfollowing surgery. Specific variables that were strongly associated with seizure-free outcome rnincluded gross total resection and seizure duration ≤ 1 year prior to surgery. These findingsrnsuggest that strict preoperative seizure control, early surgical intervention, and complete tumorrnresection increases the chance of postoperative seizure control.

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