Skip to main content
SpringerLink
Log in

Optimal seizure management in brain tumor patients

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

The mechanism of epilepsy in brain tumor patients is probably multifactorial, and its incidence depends on tumor type and location. Refractory epilepsy is common in patients with a structural brain lesion, and a role for multidrug resistance proteins has been suggested. Until now, the medical treatment of epilepsy in brain tumor patients has only been studied retrospectively. Therefore, the optimal seizure management by antiepileptic drugs (AEDs) in this patient category is essentially unsure. Choices depend on the outcome of retrospective studies, a few nonrandomized series, extrapolation from other studies in symptomatic epilepsy, and anticipated interactions, most notably between AEDs and anticancer agents. The newly developed AEDs levetiracetam and gabapentin are recommended because of good results in preliminary studies and because they do not show interactions with anticancer agents. The use of prophylactic AEDs in brain tumor patients is disputable and generally not advised.

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

Similar content being viewed by others

References and Recommended Reading

  1. Herman ST: Epilepsy after brain insult. Neurology 2002, 599(Suppl 5):S21-S26.

    Google Scholar 

  2. Hauser WA, Annegers JF, Kurland LT: Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1988, 34:453–468.

    Article  Google Scholar 

  3. Morris HH, Estes ML: Brain tumors and epilepsy. In The Treatment of Epilepsies. Principles & Practice. Edited by Wyllie E. Cleveland: Lippincott Williams & Wilkins; 2001: 615–626.

    Google Scholar 

  4. Cascino GD: Epilepsy and brain tumors: implications for treatment. Epilepsia 1990, 31(Suppl 3):S37-S44.

    PubMed  Google Scholar 

  5. Mahaley MS, Dudka L: The role of anticovulsant medications in the management of patients with anaplastic gliomas. Surg Neurol 1981, 16:399–401.

    Article  PubMed  Google Scholar 

  6. Fish DR: How do tumors cause epilepsy? In The Epilepsies. Etiologies and Prevention. Edited by Kotagal P, Lüders HO. Cleveland: Academic Press; 1999:301–314.

    Google Scholar 

  7. Morrell F, Toledo-Morell L: Secondary epileptogenesis and brain tumors. In The Epilepsies. Etiologies and Prevention. Edited by Kotagal P, Lüders HO. Cleveland: Academic Press; 1999:357–363.

    Google Scholar 

  8. Villemure JG, De Tribolet N: Epilepsy in patients with central nervous system tumors. Curr Opin Neurol 1996, 9:424–428.

    Article  PubMed  CAS  Google Scholar 

  9. Wolf HK, Roos D, Blümcke I, et al.: Perilesional neurochemical changes in focal epilepsies. Acta Neuropathologica 1996, 91:376–384.

    Article  PubMed  CAS  Google Scholar 

  10. Gilmore R, Morris H, Van Ness PC, et al.: Mirror focus: function of seizure frequency and influence on outcome after surgery. Epilepsia 1994, 35:258–263.

    Article  PubMed  CAS  Google Scholar 

  11. Bateman DE, Hardy JA, McDermott JR, et al.: Amino acid transmitter levels in gliomas and their relationship to the incidence of epilepsy. Neurol Res 1988, 10:112–114.

    PubMed  CAS  Google Scholar 

  12. Schaller B, Rüegg S: Brain tumor and seizures: pathophysiology and its implications for treatment revisited. Epilepsia 2003, 44:1223–1232.

    Article  PubMed  Google Scholar 

  13. Aronica E, Gorter JA, Jansen GH, et al.: Expression of connexion 43 and connexion 32 gap-junction proteins in epilepsyassociated brain tumors and in the perilesional epileptic cortex. Acta Neuropathol 2001, 101:449–459.

    PubMed  CAS  Google Scholar 

  14. Bourekas EC, Perl J: Imaging tumors in epilepsy. In The Epilepsies. Etiologies and Prevention. Edited by Kotagal P, Lüders HO. Cleveland: Academic Press; 1999:315–335.

    Google Scholar 

  15. Glantz MJ, Cole BF, Forsyth PA, et al.: Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors: report of quality standards subcommittee of the American Academy of Neurology. Neurology 2000, 54:1886–1893. A clear guideline on the use of prophylactic AED treatment in patients with primary and metastatic brain tumors.

    PubMed  CAS  Google Scholar 

  16. Morris HH, Estes ML, Gilmore R, et al.: Chronic intractable epilepsy as the only symptom of primary brain tumor. Epilepsia 1993, 34:1038–1043.

    Article  PubMed  CAS  Google Scholar 

  17. Wen PY, Marks PW: Medical management of patients with brain tumors. Oncology 2002, 14:299–307.

    Google Scholar 

  18. Moots PL, Maciunas RJ, Eisert DR, et al.: The course of seizure disorders in patients with malignant gliomas. Arch Neurol 1995, 52:717–724.

    PubMed  CAS  Google Scholar 

  19. Devinsky O: Patients with refractory seizures. N Engl J Med 1999, 20:1565–1570.

    Article  Google Scholar 

  20. Sisodiya SM, Lin WR, Harding BN, et al.: Drug resistance in epilepsy: expression of drug resistance proteins in common causes of refractory epilepsy. Brain 2002, 125:22–31.

    Article  PubMed  CAS  Google Scholar 

  21. Löscher W, Poitschka H: Role of multidrug transporters in pharmacoresistance to antiepileptic drugs. J Pharmacol Exper Ther 2002, 301:7–14.

    Article  Google Scholar 

  22. Rogawski MA: Does P-glycoprotein play a role in pharmacoresistance to antiepileptic drugs? Epilepsy Behav 2002, 3:493–495.

    Article  PubMed  Google Scholar 

  23. Siddiqui A, Kerb R, Weale ME, et al.: Association of multidrug resistance in epilepsy with a polymorphism in the drugtransporter gene ABCB1. N Engl J Med 2003, 348:1442–1448.

    Article  PubMed  CAS  Google Scholar 

  24. Tan B, Piwnica-Worms D, Ratner L: Multidrug resistance transporters and modulation. Curr Opin Oncol 2000, 12:450–458.

    Article  PubMed  CAS  Google Scholar 

  25. Goldman B: Multidrug resistance: can new drugs help chemotherapy score against cancer? J Natl Cancer Inst 2003, 95:255–257.

    Article  PubMed  Google Scholar 

  26. Britton JW, Cascino GD, Sharbrough FW, Kelly PJ: Low-grade glial neoplasms and intractable partial epilepsy: efficacy of surgical treatment. Epilespia 1994, 35:1130–1135.

    Article  CAS  Google Scholar 

  27. Stephen LJ, Kwan P, Brodie MJ: Does the cause of localisationrelated epilepsy influence the response to antiepileptic drug treatment? Epilepsia 2001, 42:357–362.

    Article  PubMed  CAS  Google Scholar 

  28. Wagner GL, Wilms EB, Van Donselaar CA, Vecht CJ: Levetiracetam: the preliminary experience in patients with primary brain tumours. Seizure 2003, 12:585–586.

    Article  PubMed  CAS  Google Scholar 

  29. Siddiqui F, Wen P, Dworetzky B, et al.: Use of levetiracetam in patients with brain tumors. Epilepsia 2002, 43(Suppl 7):297.

    Google Scholar 

  30. Perry JR, Sawka C: Add-on Gabapentin for refractory seizures in patients with brain tumours. Can J Neurol Sci 1996, 23:128–131.

    PubMed  CAS  Google Scholar 

  31. Franceshetti S, Binelli S, Casazza M, et al.: Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumors. Acta Neurochirurg 1990, 103:47–51.

    Article  Google Scholar 

  32. North JB, Penhall RK, Hanieh A, et al.: Phenytoin and postoperative epilepsy. J Neurosurg 1983, 58:672–677.

    Article  PubMed  CAS  Google Scholar 

  33. Shaw MDM: Post-operative epilepsy and the efficacy of anticonsulvant therapy. Acta Neurochirurg 1990, S50:55–57.

    Google Scholar 

  34. Cohen N, Strauss G, Lew R, et al.: Should prophylactic anticonsulvants be administered to patients with newlydiagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988, 6:1621–1624.

    PubMed  CAS  Google Scholar 

  35. Taphoorn JB: Neurocognitive sequelae in the treatment of low-grade gliomas. Semin Oncol 2003, 30:45–48. An interesting article showing us that not only the tumor itself and radiotherapy, but also the severity of epileptic seizures and the use of AEDs, are strongly associated with cognitive decline.

    Article  PubMed  Google Scholar 

  36. Rowan AJ, James RA: Reflections on the treatment of seizures in the elderly population. Neurology 1998, 51:S28-S33.

    PubMed  CAS  Google Scholar 

  37. Baker AF, Dorr RT: Drug interactions with the taxanes: clinical implications. Cancer Treat Rev 2001, 27:221–233.

    Article  PubMed  CAS  Google Scholar 

  38. Vecht CJ, Wagner L, Wilms EB: Interactions between antiepileptic and chemotherapeutic drugs. Lancet 2003, 2:404–409.

    Article  CAS  Google Scholar 

  39. Grossman SA, Hochberg F, Fisher J, et al.: Increase 9-aminocamtothecin dose requirements in patients on anticonsulvants. Cancer Chenother Pharmacol 1998, 42:118–126.

    Article  CAS  Google Scholar 

  40. Neef C, de Voogd-van der Straaten I: An interaction between cytostatic and anticonsvulsant drugs. Clin Pharmacol Ther 1998, 43:372–375.

    Article  Google Scholar 

  41. Gilber PJ, Brodribb TR: Phenytoin and fluorouracil interaction. Ann Pharmacother 2001, 35:1367–1370.

    Article  Google Scholar 

  42. Cascino GD: Surgical treatment for epilepsy. Epilepsy Res 2004, 60:179–186. A clear review describing the importance of early and effective epilepsy surgery looking at seizure frequency and quality of life.

    Article  PubMed  Google Scholar 

  43. Zentner J, Hufnagel A, Wolf HK, et al.: Surgical treatment of neplasms associated with medically intractable epilepsy. Neurosurgery 1997, 41:378–386.

    Article  PubMed  CAS  Google Scholar 

  44. Morris HH, Matkovic Z, Estes ML, et al.: Ganglioglioma and intractable epilepsy: clinical and neurophysiologic features and predictors of outcome after surgery. Epilepsia 1998, 39:307–313.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  46. Brainer-Lima PT, Rao S, Cukiert A, et al.: surgical treatment of refractory epilepsy associated with space occupying lesions. Arq Neuropsiquiatr 1996, 54:384–392.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Medical Center The Hague, 2501, CK, The Hague, The Netherlands

    Charles J. Vecht MD, PhD

Authors
  1. Melanie S. M. van Breemen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles J. Vecht MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Breemen, M.S.M., Vecht, C.J. Optimal seizure management in brain tumor patients. Curr Neurol Neurosci Rep 5, 207–213 (2005). https://doi.org/10.1007/s11910-005-0048-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-005-0048-6

Keywords

Search

Navigation