Nationwide registry-linked retrospective cohort study of Ganglioglioma in children and adults: Long-term follow-up of anti-seizure medication and mortality.
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PURPOSE: Gangliogliomas are highly epileptogenic tumors that are common in epilepsy surgery. The main aim of this study was to investigate whether the outcome of Anti-seizure medication (ASM) withdrawal differed between patients undergoing ganglioglioma surgery in an epilepsy surgery program compared with those who underwent surgery in other surgical programs. We also investigated which factors influence ASM discontinuation after ganglioglioma surgery. METHOD: We achieved a nationwide Swedish coverage by retrieving and linking data from five registries, including 144 patients of all ages with surgically confirmed ganglioglioma (ICD-O-95051/95053) treated between 2005 and 2019. Cases required concordance across registries and unmatched records were excluded. Key variables included age at surgery, waiting time for surgery, and tumor location, along with demographic, surgical, and ASM-related data. ASM discontinuation was defined as a 14-month dispensing-free interval. Associations with ASM discontinuation were examined using nonparametric tests, Kaplan-Meier estimates and Cox regression. RESULTS: Most patients, 76%, had been prescribed ASM during the study period. Increasing age was found to be negatively associated with ASM withdrawal. Five years after surgery, 36% of adults and 59% of children had discontinued ASMs. There was no difference in ASM withdrawal in patients who had undergone surgery in an epilepsy surgery program compared with those who had not. Mortality was 15% overall. CONCLUSIONS: This study demonstrates that long-term ASM discontinuation after ganglioglioma surgery is negatively associated with increasing age. ASM discontinuation is the same for those undergoing surgery in an epilepsy surgery program as for those who do not. Future studies are needed to explore why older patients are less likely to discontinue ASM treatment after ganglioglioma surgery.