Seizures at presentation are correlated with better survival outcomes in adult diffuse glioma: A systematic review and meta-analysis. 
Seizures are the most common presenting sign of patients with diffuse glioma.  In the current study, we performed a meta-analysis to determine the correlation of seizures at presentation to survival outcomes in adult diffuse glioma, and the possible mechanisms were also discussed.  A comprehensive literature search was performed in PUBMED, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials.  The pooled hazard ratio (HR) and corresponding 95% confidence interval (CI) were used to estimate effects.  Heterogeneity among studies and publication bias were also evaluated.  11 studies with 2088 patients were finally included for the current meta-analysis.  Seizure-free preoperatively was significantly associated with a poor overall survival in patients with diffuse glioma, the pooled HR was 1.73 (95% CI 1.43-2.08, Z = 5.71, p < 0.001).  Subgroup analysis was also performed by tumor grade, the same association was identified in both low-grade glioma (pooled HR 2.49, 95% CI 1.47-4.20, Z = 3.40, p < 0.001) and glioblastoma (pooled HR 1.46, 95% CI 1.27-1.68, Z = 5.24, p < 0.001).  A significant correlation of seizure-free with a poor progression-free survival was also identified (pooled HR 1.42, 95% CI 1.06-1.92, Z = 2.33, p = 0.02), although only 3 studies comprising 368 patients were included.  The current study determined that seizures at presentation were an independent predictor of better survival outcomes in adult diffuse glioma.  It is the first study which provides a comprehensive standardized assessment of the association between seizures at presentation with long-term survival outcomes in patients with diffuse glioma.