Skip to main content
SpringerLink
Log in

Chirurgisches Management tumorassoziierter Epilepsie

Management of tumor-associated epilepsy

  • Leitthema
  • Published:
Zeitschrift für Epileptologie Aims and scope Submit manuscript

Zusammenfassung

Patienten mit Hirntumoren leiden häufig an epileptischen Anfällen. Etwa jeder zehnte Patient im Erwachsenenalter mit erstmaligem Anfall hat einen Hirntumor; abhängig von histologischem Befund und Lokalisation des Tumors haben 15 bis > 90% der Patienten Anfälle. Für Diagnostik und Operationsstrategie ist die Unterscheidung zwischen einer Epilepsie mit einzelnen Anfällen und einer medikamentös therapierefraktären Epilepsie notwendig. Die erfolgreiche operative Behandlung therapierefraktärer Anfälle setzt voraus, dass neben der Resektion des Tumors (der Läsion) auch das epileptogene Areal entfernt wird. Neben bildgebenden Untersuchungen wird dafür im Rahmen der prächirurgischen Diagnostik eine eingehende elektrophysiologische Aufarbeitung notwendig, u. U. mit implantierten Elektroden. Besteht eine Epilepsie mit einzelnen Anfällen reicht meist ein Standard-MRT; angestrebt wird eine möglichst komplette Tumorresektion. Die neurochirurgische Therapie verbessert die Anfallssituation meist dramatisch; selbst bei refraktärer Epilepsie wird bei bis zu 80% der Patienten Anfallsfreiheit erreicht. Bestrahlungs- und Chemotherapie bei Hirntumoren scheinen einen günstigen, allerdings nur wenig ausgeprägten Einfluss auf eine tumorassoziierte Epilepsie zu haben.

Abstract

Patients with brain tumors often suffer from tumor-associated epilepsy. Approximately 10% of adult patients with a first unprovoked seizure may harbor a brain tumor. Depending on histology and location of the brain tumor, between 15% and > 90% of the patients may develop epilepsy. The diagnostic work-up as well as resection planning differ crucially between patients with symptomatic epilepsy and sporadic seizures, and cases with pharmacoresistant epilepsy. The presurgical work-up in patients with refractory seizures comprise MRI (plus additional imaging modalities), interictal and ictal EEG, and in some cases surgical implantation of electrodes. It aims at the delineation of the epileptogenic area which needs to be resected in addition to the tumor in order to cure the patient’s epilepsy. In cases with sporadic seizures (i.e., non-pharmacorefractory epilepsy), a standard MRI is sufficient and the surgical aim is complete tumor resection. Neurosurgery for tumor-associated epilepsy usually has very good results; in more than 80% of patients with refractory epilepsy complete seizure control can be achieved. Radiation or chemotherapy of brain tumors may have minor beneficial effects on tumor-associated epilepsy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Aaronson NK, Taphoorn MJ, Heimans JJ et al (2011) Compromised health-related quality of life in patients with low-grade glioma. J Clin Oncol 29:4430–4435

    Article  PubMed  Google Scholar 

  2. Berkovic SF, McIntosh AM, Kalnins RM et al (1995) Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology 45:1358–1363

    PubMed  CAS  Google Scholar 

  3. Cascino GD, Kelly PJ, Sharbrough FW et al (1992) Long-term follow-up of stereotactic lesionectomy in partial epilepsy: predictive factors and electroencephalographic results. Epilepsia 33:639–644

    Article  PubMed  CAS  Google Scholar 

  4. Chaichana KL, Parker SL, Olivi A et al (2009) Long-term seizure outcomes in adult patients undergoing primary resection of malignant brain astrocytomas. Clinical article. J Neurosurg 111:282–292

    Article  PubMed  Google Scholar 

  5. Chalifoux R, Elisevich K (1996) Effect of ionizing radiation on partial seizures attributable to malignant cerebral tumors. Stereotact Funct Neurosurg 67:169–182

    Article  PubMed  Google Scholar 

  6. Chang EF, Potts MB, Keles GE et al (2008) Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg 108:227–235

    Article  PubMed  Google Scholar 

  7. Chang EF, Quigg M, Oh MC et al (2010) Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy. Neurology 74:165–172

    Article  PubMed  CAS  Google Scholar 

  8. Clusmann H, Kral T, Fackeldey E et al (2004) Lesional mesial temporal lobe epilepsy and limited resections: prognostic factors and outcome. J Neurol Neurosurg Psychiatry 75:1589–1596

    Article  PubMed  CAS  Google Scholar 

  9. Groot M de, Reijneveld JC, Aronica E et al (2011) Epilepsy in patients with a brain tumour: focal epilepsy requires focused treatment. Brain. DOI 10.1093/brain/awr310

  10. Forsgren L, Bucht G, Eriksson S et al (1996) Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia 37:224–229

    Article  PubMed  CAS  Google Scholar 

  11. Glantz MJ, Cole BF, Forsyth PA et al (2000) Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 54:1886–1893

    PubMed  CAS  Google Scholar 

  12. Kaal EC, Taphoorn MJ, Vecht CJ (2005) Symptomatic management and imaging of brain metastases. J Neurooncol 75:15–20

    Article  PubMed  Google Scholar 

  13. Kurzwelly D, Herrlinger U, Simon M (2010) Seizures in patients with low-grade gliomas – incidence, pathogenesis, surgical management, and pharmacotherapy. Adv Tech Stand Neurosurg 35:81–111

    Article  PubMed  CAS  Google Scholar 

  14. Kwan P, Schachter SC, Brodie MJ (2011) Drug-resistant epilepsy. N Engl J Med 365:919–926

    Article  PubMed  CAS  Google Scholar 

  15. Lieu AS, Howng SL (2000) Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res 38:45–52

    Article  PubMed  CAS  Google Scholar 

  16. Luyken C, Blumcke I, Fimmers R et al (2003) The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44:822–830

    Article  PubMed  Google Scholar 

  17. Luyken C, Blumcke I, Fimmers R et al (2004) Supratentorial gangliogliomas: histopathologic grading and tumor recurrence in 184 patients with a median follow-up of 8 years. Cancer 101:146–155

    Article  PubMed  Google Scholar 

  18. Majores M, Lehe M von, Fassunke J et al (2008) Tumor recurrence and malignant progression of gangliogliomas. Cancer 113:3355–3363

    Article  PubMed  Google Scholar 

  19. Oberndorfer S, Piribauer M, Marosi C et al (2005) P450 enzyme inducing and non-enzyme inducing antiepileptics in glioblastoma patients treated with standard chemotherapy. J Neurooncol 72:255–260

    Article  PubMed  CAS  Google Scholar 

  20. Prayson RA, Fong J, Najm I (2010) Coexistent pathology in chronic epilepsy patients with neoplasms. Mod Pathol 23:1097–1103

    Article  PubMed  Google Scholar 

  21. Rathore C, Panda S, Sarma PS et al (2011) How safe is it to withdraw antiepileptic drugs following successful surgery for mesial temporal lobe epilepsy? Epilepsia 52:627–635

    Article  PubMed  Google Scholar 

  22. Rogers LR, Morris HH, Lupica K (1993) Effect of cranial irradiation on seizure frequency in adults with low-grade astrocytoma and medically intractable epilepsy. Neurology 43:1599–1601

    PubMed  CAS  Google Scholar 

  23. Rossi GF, Pompucci A, Colicchio G et al (1999) Factors of surgical outcome in tumoural epilepsy. Acta Neurochir (Wien) 141:819–824

    Google Scholar 

  24. Schramm J, Kral T, Grunwald T et al (2001) Surgical treatment for neocortical temporal lobe epilepsy: clinical and surgical aspects and seizure outcome. J Neurosurg 94:33–42

    Article  PubMed  CAS  Google Scholar 

  25. Sherman JH, Moldovan K, Yeoh HK et al (2011) Impact of temozolomide chemotherapy on seizure frequency in patients with low-grade gliomas. J Neurosurg 114:1617–1621

    Article  PubMed  Google Scholar 

  26. Simon M, Neuloh G, Lehe M von et al (2009) Insular gliomas: the case for surgical management. J Neurosurg 110:685–695

    Article  PubMed  Google Scholar 

  27. Simon M, Schramm J (2009) Surgical management of intracranial gliomas. Recent Results Cancer Res 171:105–124

    Article  PubMed  Google Scholar 

  28. Sirven JI, Wingerchuk DM, Drazkowski JF et al (2004) Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc 79:1489–1494

    Article  PubMed  Google Scholar 

  29. Smith JS, Chang EF, Lamborn KR et al (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345

    Article  PubMed  Google Scholar 

  30. Urbach H (2008) MRI of long-term epilepsy-associated tumors. Semin Ultrasound CT MR 29:40–46

    Article  PubMed  Google Scholar 

  31. Wick W, Menn O, Meisner C et al (2005) Pharmacotherapy of epileptic seizures in glioma patients: who, when, why and how long? Onkologie 28:391–396

    Article  PubMed  CAS  Google Scholar 

  32. Williams BJ, Suki D, Fox BD et al (2009) Stereotactic radiosurgery for metastatic brain tumors: a comprehensive review of complications. J Neurosurg 111:439–448

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Neurochirurgie, Universität Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    M. von Lehe, J. Schramm & M. Simon

Authors
  1. M. von Lehe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Schramm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. von Lehe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

von Lehe, M., Schramm, J. & Simon, M. Chirurgisches Management tumorassoziierter Epilepsie. Z. Epileptol. 25, 96–103 (2012). https://doi.org/10.1007/s10309-011-0216-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10309-011-0216-4

Schlüsselwörter

Keywords

Search

Navigation