| Abstract [eng] |
Gliomas are the most common primary tumours in the central nervous system (CNS) that cause seizures in more than 50% of cases and resistance to antiepileptic drug treatment in approximately 30% of cases. This poses a great challenge for the clinician and particularly for the patient since it is associated with poor quality of life and antitumoural treatment results for the patient. When a CNS tumour is diagnosed, etiologic treatment (surgery, radiotherapy, chemotherapy) is needed which can be combined with symptomatic treatment for the seizures. However, tumour resection in reducing postoperative seizures or achieving seizure-freedom is effective in around 70% of cases. Therefore, understanding tumorigenesis and epileptogenesis, improving their diagnostic work-up and optimal treatment could be valuable. Pathogenesis in brain tumour related epilepsy is complex and unknown to a large extent. To date, proposed mechanisms rely on 1) CNS tumour’s histological grade, genetic and molecular markers, location in the brain; 2) tumour’s mass effect and secretory function which results in secondary changes: disturbance in blood circulation and blood-brain barrier function; hypoxia and inflammatory processes; dysbalance in functions of electrolytes and neurotransmitters. These factors may contribute to neuronal hyperexcitability and hypersinchronisation which leads to the formation of a vicious cycle in the brain. Using non-invasive and minimally invasive diagnostical tools helps to precisely identify both the tumour and the pathological peritumoural area resulting in a more optimized surgical resection. Radical lesionectomy with extension in some cases is directly related to better tumour and postoperative seizure control outcomes. Additionally, a rare case report of infant-type hemispheric glioma in a 10-month-old patient is presented. This tumour was recognised as a separate entity by the World Health Organisation CNS tumour classification only in the year 2021. The patient initially presented with severe seizures. Head magnetic resonance imaging and electroencephalogram were performed which showed a large mass in the brain and epileptic activity in the associated area. Excisional biopsy was performed which showed signs of anaplastic glioma at first, but later methylation and specific tumour markers confirmed it to be high-grade infantile glioma. Radical tumour removal was achieved with good tumour and seizure-freedom control results postoperatively. This narrative review of the literature describes the mechanisms of epileptogenesis induced by brain tumours, its diagnostic and therapeutic implications, and presents a case report of a successfully treated very rare brain tumour - infantile hemispheric glioma. |
