Patients with incidental WHO grade II glioma frequently suffer from neuropsychological disturbances

Plastic relocation of motor cortex in a patient with LGG (low grade glioma) confirmed by NBS (navigated brain stimulation)

Acta Neurochir (2016) 158:305–312

WHO grade II gliomas (low-grade glioma, LGG) are increasingly diagnosed in patients undergoing MRI for many conditions. These patients are classically considered asymptomatic because they do not experience seizures. Although it was previously demonstrated that symptomatic LGG patients frequently have neurocognitive disorders, the literature does not provide data on the neuropsychological status of patients with incidental LGG (iLGG).

Objective Our aim is to investigate whether neurocognitive impairments exist in a homogeneous iLGG population.

Methods We conducted an analysis of pretreatment neuropsychological assessments of patients with iLGG (histologically proven) admitted to our center from 2007 to 2014. We also obtained data on subjective complaints, tumor size and location.

Results Our study focused on 15 iLGG patients. Two thirds reported subjective complaints, mainly tiredness (40 %) and attentional impairment (33 %). Neurocognitive functions were disturbed in 60 % of patients; 53 % had altered executive functions, 20 % had working memory impairment, and 6 % had attentional disturbances. Only one patient with normal preoperative neuropsychological assessment experienced a deficit at the 3-month postoperative examination.

Conclusions For the first time to our knowledge, we suggest that numerous iLGG patients have neuropsychological impairments. Therefore, greater attention should be paid to objective neuropsychological assessment in iLGG because of the high prevalence of insidious cognitive deficits. Moreover, our original findings bring into question the traditional wait-andsee attitude in iLGG, mainly based on the erroneous dogma that these patients have no functional disturbances. Neuropsychological assessment is mandatory to select the best individualized therapeutic management with preservation of quality of life.

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