Brain regions associated with frequent occurrences of seizures related to low-grade gliomas: a voxel-level evidence.

Background: Tumor location has been demonstrated to influence the risk of epilepsy in patients with low-grade gliomas (LGGs). However, existing evidence is mainly based on dichotomized analyses, without adequately accounting for seizure frequency. We present a voxel-wise lesion analysis to investigate the potential correlations between the location of tumor and the frequency of seizure occurrence in patients with LGGs. Methods: We retrospectively reviewed the clinical information and magnetic resonance images of 352 patients pathologically confirmed with LGGs. Preoperative seizure frequency during the 3 months prior to the primary surgery was classified as daily (≥1/day), weekly (≥1/week), monthly (≥1/month) and rare (<1/month). A voxel-based lesion-symptom mapping analysis was performed to identify the association between tumor location and preoperative seizure frequency. Results: LGGs involving the left primary motor area or right insular and basal ganglia were associated with an increased risk of frequent seizures (≥1/month). A focal aware seizure was more likely to frequently occur compared with a focal to bilateral tonic-clonic seizure caused by LGGs ( Conclusion: This study utilized voxel-level neuroimaging analyses to identify the anatomical correlations of seizure frequency in patients with LGGs, providing further insight into seizure risk stratification and potential implications for surgical management.