Studeniak T. Predictors of the development and dynamics of epileptic seizures in patients with supratentorial brain meningiomas

The dissertation presents the theoretical generalization, definition and practical application of clinical, pathohistological and neuroimaging criteria - predictors of the development and course of epileptic seizures in patients with supratentorial meningiomas. The influence of various factors on the probability of developing epileptic seizures and their persistence after surgical treatment of meningioma has been clarified. Namely, it was found that epileptic seizures were found in 41.3% of patients with supratentorial meningiomas of the brain. It was determined that the smaller the meningioma, the more likely it will be manifested by epileptic seizures (p <0.05). Psammomatous meningioma is characterized by the highest frequency of attacks among all histological types and subtypes of the tumor - they were observed in 2/3 (66.7 ± 10.5%) of patients with this subtype of meningioma. Epileptic seizures have been found to be the most common first clinical manifestation of meningioma and rarely occur in patients with other clinical manifestations of the tumor. Only in a small number of cases (6.6%) epileptic seizures developed as the second or third clinical manifestation of the disease. It has been studied that the male sex is associated with a higher probability of developing epileptic seizures, and the localization of meningioma in the area of the saddle tubercle is significantly less likely to cause seizures. Epileptic seizures were more common in patients aged 41-50 years. This age group was 28.0 ± 4.5% of patients with seizures, in contrast to 19.0 ± 3.3% in the group without seizures Epileptic seizures after surgery did not regress only in ¼ (24.7%) cases. At the same time, 8.7% had seizures for the first time after meningioma removal. It was found that the duration of the disease longer than a year (p<0.05), as well as the presence of more than 10 attacks before surgery (p<0.05), increase the likelihood of seizures. Brain edema around the tumor is a strong predictor of both the development and persistence of epileptic seizures p<0,01. The incidence of early complications was 2.0 ± 1.4% among patients with seizures and 4.9 ± 1.8% among patients without seizures. In group 1 there was one early postoperative lethal case, and in group 2 - three. In percentage, it is 1.0 ± 1.0%, and 2.1 ± 1.2%, respectively. Reliable data that the presence of epileptic seizures affects the risk of neurological deficits, complications and mortality not founded (p>0,05). A scale for predicting the persistence of epileptic seizures after surgery in patients with supratentorial meningiomas of the brain has been developed. This scale takes into account the patient's gender, tumor size and location, disease duration, EEG data, and histological diagnosis. Based on the scale, a therapeutic algorithm was developed for using antiepileptic drugs after surgical treatment of meningioma.