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Onco-Epilepsy: More Than Tumor and Seizures

      Seizures are a potentially devastating complication of brain tumors
      • Stupp R.
      • Mason W.P.
      • van den Bent M.J.
      • et al.
      European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma.
      and negatively affect quality of life and neurocognitive function,
      • Klein M.
      • Engelberts N.H.
      • van der Ploeg H.M.
      • et al.
      Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life.
      with a burden of disease that includes psychosocial, economic, and management ramifications.
      • Bartolomei F.
      • Bosma I.
      • Klein M.
      • et al.
      How do brain tumors alter functional connectivity? A magnetoencephalography study.
      Both gliomas and seizures arise directly from the brain and alter multiple large-scale networks of neuronal function and connectivity, leading to bihemispheric disruption.
      • Englot D.J.
      • Hinkley L.B.
      • Kort N.S.
      • et al.
      Global and regional functional connectivity maps of neural oscillations in focal epilepsy.
      Changes in functional connectivity affecting both hemispheres of patients have been found using electroencephalography, magnetoencephalography, functional magnetic resonance imaging, and magnetic resonance tractography despite the presence of a tumor isolated to a single hemisphere.
      • Bartolomei F.
      • Bosma I.
      • Klein M.
      • et al.
      How do brain tumors alter functional connectivity? A magnetoencephalography study.
      Widespread global decreases in functional connectivity observed in patients with focal epilepsy probably reflect the deleterious electrophysiological effects of recurrent seizures as opposed to primarily metabolic alterations in remote areas.
      • Englot D.J.
      • Hinkley L.B.
      • Kort N.S.
      • et al.
      Global and regional functional connectivity maps of neural oscillations in focal epilepsy.
      Magnetoencephalographic recordings have exhibited similar alterations in functional connectivity in broadband frequency (0.5-60 Hz) and gamma frequency (30-80 Hz) analyses widely distributed in remote areas of the brain in patients with tumor.
      • Bartolomei F.
      • Bosma I.
      • Klein M.
      • et al.
      How do brain tumors alter functional connectivity? A magnetoencephalography study.
      Electrophysiological techniques correlating frequency domains and measures of Granger causality phase locking in gliomas and epilepsy could provide a link to the global network disruption caused by seizures.
      • Englot D.J.
      • Hinkley L.B.
      • Kort N.S.
      • et al.
      Global and regional functional connectivity maps of neural oscillations in focal epilepsy.
      Even gross total resection of brain tumors and a suspected epileptogenic zone may not result in successful outcomes because of preexisting functional connectivity in remaining brain regions.
      • Bartolomei F.
      • Bosma I.
      • Klein M.
      • et al.
      How do brain tumors alter functional connectivity? A magnetoencephalography study.
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