Neurológia pre prax 5/2009

Low-grade glioma (fibrilary astrocytoma) and epilepsy

Patients with low grade glioma and symptomatic focal epilepsy represent a complicated clinical problem. A case report of now 37 years old female successfully treated with temozolomid is presented here. She had her first secondarily generalized epileptic seizure in postpartum period. MRI discovered low grade glioma in the right parietal region. Her epilepsy soon proved refractory to treatment. Because of epilepsy farmacoresistancy and tumor growth on MRI neurosurgery was indicated. Only partial resection was done due to risk of permanent motor deficit. Histopathology exam diagnosed fibrilary astrocytoma WHO II. Further growth of the tumor was noted on MRI three years later. The choise of temozolomid as most suitable treatment was based on thorough interdisciplinary discussion including assesing the risks of alternative treatments, neurosurgery and radiotherapy. After 12 month of treatment with temozolomid the tumor ceased to grow and remains unchanged in size for four years. Epilepsy is reasonably controled without change in medication. Treatment with temozolomid is not a standard option in treatment of low grade gliomas. An overview of data on this issue available in the literature is presented here for discussion.

Keywords: low-grade glioma, fibrillary astrocytoma, symptomatic focal epilepsy, temozolomide.