Silent seizures in glioma: The role of preoperative EEG in detecting electrographic seizures

Abstract

Seizures are a common presentation in glioma patients, yet electrographic seizures — subclinical seizure activity detected only on electroencephalography (EEG) are often overlooked due to the lack of routine EEG screening. This case report describes a glioma patient who presented with worsening occipital headaches and cognitive decline but no overt seizures. Preoperative EEG revealed an electrographic seizure originating from the left temporal region, despite the absence of clinical manifestations. The patient underwent surgical resection, and histology confirmed a WHO grade 4 IDH-mutant astrocytoma. This case highlights the importance of proactive EEG screening, even in the absence of clinical seizures, as it facilitated early seizure detection and treatment. Further studies are needed to evaluate the impact of treating electrographic seizures on long-term outcomes in glioma.