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Clinical Presentation in Diffuse Low-Grade Gliomas

Chapter in book
Authors Anja Smits
Asgeir Store Jakola
Published in Diffuse Low-Grade Gliomas in Adults, Editors: Duffau, Hugues (Ed.)
Pages 199-213
ISBN 978-3-319-55466-2
Publisher Springer International Publishing
Place of publication London
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages 199-213
Language en
Links https://doi.org/10.1007/978-3-319-5...
Keywords Diffuse low-grade gliomas, Clinical symptoms, Disease onset, Epileptic seizures, Cognitive deficits
Subject categories Clinical Medicine

Abstract

Due to the slow growth of DLGG with frequent involvement of eloquent areas and diffuse infiltration of subcortical pathways, the clinical presentation of patients with DLGG shows a large variety. The natural course of DLGG is considered to occur as a continuum with an initial silent period, followed by a symptomatic period characterized by new-onset seizures but without functional deficits, and a final period of malignant progression where focal deficits or increased intracranial pressure may occur. However, such a schematic view of the step-wise development of DLGG over time may be misleading. Recent literature gives support for a high prevalence of subjective complaints and minor cognitive deficits already during the silent phase of DLGG when tumor diagnosis is still unknown, suggesting that patients with incidental DLGG should be considered as “not yet diagnosed” rather than “asymptomatic”. These insidious symptoms may be unrecognized but present and affect emotional and cognitive functions. Also, malignant tumor transformation can precede the development of clinical symptoms for long periods of time, indicating that the absence of progressive symptoms does not protect against malignant transformation. Not surprisingly, the feeble association between tumor-related symptoms and signs on one hand and the natural course of disease on the other makes traditional clinical surveillance (“watchful waiting”) inadequate to detect important biological changes within DLGG. As the biological clock is about to change from a slow and continuous growth towards a more aggressive biology, there is a fine line between what is considered “too early” and what may be “too late” with respect to tumor treatment. A more comprehensive understanding of the tumor-related symptoms and signs at presentation, including how these parameters are correlated with molecular tumor characteristics, is a prerequisite for optimal clinical management.

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