Epilepsie und Neurokognition bei Patienten mit Glioblastom

Epilepsy is a common symptom in patients with glioblastoma, often leading to first diagnosis. Many of these patients are treated with antiepileptic medication. However, especially for patients with very occasional, focal seizures the decision-making regarding anticonvulsive treatment remains a matter of discussion. Some studies suggest an impact of epilepsy and its treatment on neurocognition and mood. The aim of this study was to describe the prevalence and use of antiepileptic drugs before therapy and during the course of disease, and to analyse correlations with neurocognitive performance.

226 patients with untreated glioblastomas underwent neurocognitive assessment composed of 11 subtests, complemented by a standard questionnaire to assess depression (Becks Depression Index). Moreover, information on epileptic history and the use of antiepileptic drugs were collected from the attending physicians before and after first surgery, and after 3 and 6 months. Neurocognitive data were normalised to percentile ranks. Pearson"s point-biserial correlations were calculated to examine relationships between neurocognitive performance and epilepsy as well as use of antiepileptic medication. Chi-squared tests were applied to evaluate the relationship between epilepsy (treatment) and binomial factors. Correction for multiple comparisons was applied.

Preoperatively, 22% were reported to suffer from (mostly focal) epilepsy. 28% received antiepileptic treatment (84% levetiracetam-based medication). Seizures during the acute postoperative phase occurred overall in 3.6% of the patients, largely irrespective of preoperative epilepsy (4.8% vs. 3.5%; n.s.). The prevalence of epilepsy did not significantly change over time. Patients with epilepsy showed, overall, non-inferior neurocognitive test performance. Interestingly, they even showed better performance than non-epileptic patients in visuospatial processing (p=0.05), especially when under anticonvulsive medication (p=0.003). In contrast, we found no significant association of epilepsy with depression or the IDH mutation status. Of note, tumour volumes of epilepsy patients were not different from others (p=0.899).

Our data showed no negative effect of epilepsy and related medical treatment on neurocognitive functions, and even support the hypothesis that the use of levetiracetam has a positive impact on visuospatial abilities. This seems worthy of consideration for clinical decision-making.