Clinical practice guidelines for the diagnosis and treatment of diffuse glioma-related epilepsy: 2025 update

Area of Science:

• Neuroscience
• Oncology
• Epileptology

Background:

• Diffuse glioma-related epilepsy (dGRE) is a common initial symptom of glioma, linked to tumor progression and recurrence.
• The complex pathogenesis involves peritumoral microenvironment and tumor-intrinsic factors.
• dGRE imposes substantial social and psychological burdens on patients.

Purpose of the Study:

• To summarize the diagnosis and management of dGRE.
• To present the updated 2025 Chinese clinical practice guidelines for dGRE.
• To provide an evidence-based reference for standardized dGRE care.

Main Methods:

• Comprehensive diagnostic approach integrating neuroimaging, EEG, and molecular biomarkers.
• Spatial correlation analysis between tumor and epileptogenic zone.
• Review of current therapeutic strategies including anti-seizure medications (ASMs), surgery, radiotherapy, and chemotherapy.

Main Results:

• Non-enzyme-inducing ASMs (e.g., levetiracetam, lacosamide) are first-line; valproic acid is second-line.
• Maximal safe surgical resection guided by electrophysiological monitoring improves seizure outcomes.
• The 2025 guidelines incorporate advances in ASM use, postoperative withdrawal, and multidisciplinary treatment.

Conclusions:

• Standardized diagnosis of dGRE requires integrating multiple modalities.
• Effective management involves a combination of pharmacotherapy, surgery, and potentially other oncological treatments.
• The updated guidelines aim to optimize seizure control and patient prognosis in dGRE.