Temozolomide in low-grade gliomas: living longer and better (Journal of Neurology, Neurosurgery, and Psychiatry)

Low-grade gliomas (LGGs) account for about a third of gliomas overall and 15% of all primary brain tumours. In adults, the majority of LGGs are WHO Grade II astrocytomas and oligodendrogliomas, which differ in molecular fingerprints and median survival, but share a propensity to malignant transformation after a number of years. Up to 90% of LGGs present with seizures and epilepsy may be the only symptom for many years, significantly impairing quality of life and impacting on social and professional functioning.1 In about 50% of cases, the epilepsy is refractory to antiepileptic drugs (AEDs) with a quarter of patients requiring 3 or more AEDs.2 Koekkoek et al3 report on the effect of temozolomide (TMZ), an oral alkylating chemotherapy agent, on seizures in LGG, and surprisingly find a positive impact on prognosis in those patients deriving significant seizure reduction. Owing to the large variability...