Neurological Sciences

, Volume 40, Issue 10, pp 2217–2234 | Cite as

Management of epilepsy in brain tumors

  • Marta MaschioEmail author
  • Umberto Aguglia
  • Giuliano Avanzini
  • Paola Banfi
  • Carla Buttinelli
  • Giuseppe Capovilla
  • Marina Maria Luisa Casazza
  • Gabriella Colicchio
  • Antonietta Coppola
  • Cinzia Costa
  • Filippo Dainese
  • Ornella Daniele
  • Roberto De Simone
  • Marica Eoli
  • Sara Gasparini
  • Anna Teresa Giallonardo
  • Angela La Neve
  • Andrea Maialetti
  • Oriano Mecarelli
  • Marta Melis
  • Roberto Michelucci
  • Francesco Paladin
  • Giada Pauletto
  • Marta Piccioli
  • Stefano Quadri
  • Federica Ranzato
  • Rosario Rossi
  • Andrea Salmaggi
  • Riccardo Terenzi
  • Paolo Tisei
  • Flavio Villani
  • Paolo Vitali
  • Lucina Carla Vivalda
  • Gaetano Zaccara
  • Alessia Zarabla
  • Ettore Beghi
  • On behalf of Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE)
Healthcare Organization


Epilepsy in brain tumors (BTE) may require medical attention for a variety of unique concerns: epileptic seizures, possible serious adverse effects of antineoplastic and antiepileptic drugs (AEDs), physical disability, and/or neurocognitive disturbances correlated to tumor site. Guidelines for the management of tumor-related epilepsies are lacking. Treatment is not standardized, and overall management might differ according to different specialists. The aim of this document was to provide directives on the procedures to be adopted for a correct diagnostic-therapeutic path of the patient with BTE, evaluating indications, risks, and benefits. A board comprising neurologists, epileptologists, neurophysiologists, neuroradiologists, neurosurgeons, neuro-oncologists, neuropsychologists, and patients’ representatives was formed. The board converted diagnostic and therapeutic problems into seventeen questions. A literature search was performed in September–October 2017, and a total of 7827 unique records were retrieved, of which 148 constituted the core literature. There is no evidence that histological type or localization of the brain tumor affects the response to an AED. The board recommended to avoid enzyme-inducing antiepileptic drugs because of their interference with antitumoral drugs and consider as first-choice newer generation drugs (among them, levetiracetam, lamotrigine, and topiramate). Valproic acid should also be considered. Both short-term and long-term prophylaxes are not recommended in primary and metastatic brain tumors. Management of seizures in patients with BTE should be multidisciplinary. The panel evidenced conflicting or lacking data regarding the role of EEG, the choice of therapeutic strategy, and timing to withdraw AEDs and recommended high-quality long-term studies to standardize BTE care.


Epilepsy Brain tumors Antiepileptic drugs Quality of life Side effects Interaction 


Compliance with ethical standards

Conflict of interest

Dr. Marta Maschio has received support to travel to congresses from Eisai Srl, has participated in scientific advisory boards for Eisai Srl, has participated in pharmaceutical industry sponsored symposia for UCB Pharma, and has received research grants from UCB Pharma. Dr. Angela La Neve has received speaker’s or consultancy fees from Eisai Srl, Mylan, Sanofi-Aventis, and UCB Pharma. Dr. Gaetano Zaccara has received speaker’s or consultancy fees from Eisai Srl, Sanofi-Aventis, and UCB Pharma. Dr. Cinzia Costa has received speaker’s or consultancy fees from Eisai Srl, FIDIA, Mylan, and UCB. Dr. Filippo Dainese has received speaker’s or consultancy fees from Eisai and UCB Pharma. Dr. Umberto Aguglia has received research grants from Biogen. Dr. Ettore Beghi has received grants from UCB Pharma and grants from Italian Ministry of Health. Dr. Federica Ranzato has participated in hospital meetings and sponsored symposia from UCB Pharma and Eisai Srl.00. The other authors declare that they have no conflict of interest.

Supplementary material

10072_2019_4025_MOESM1_ESM.docx (24 kb)
ESM 1 Details about panel members and role. (DOCX 24 kb)
10072_2019_4025_MOESM2_ESM.docx (177 kb)
ESM 2 Literature search strategy. (DOCX 177 kb)
10072_2019_4025_MOESM3_ESM.docx (115 kb)
ESM 3 Complete list of point questions (collected in domains) and of the assigned literature (DOCX 114 kb)


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  • Marta Maschio
    • 1
    Email author
  • Umberto Aguglia
    • 2
  • Giuliano Avanzini
    • 3
  • Paola Banfi
    • 4
  • Carla Buttinelli
    • 5
  • Giuseppe Capovilla
    • 6
  • Marina Maria Luisa Casazza
    • 7
  • Gabriella Colicchio
    • 8
  • Antonietta Coppola
    • 9
  • Cinzia Costa
    • 10
  • Filippo Dainese
    • 11
  • Ornella Daniele
    • 12
  • Roberto De Simone
    • 13
  • Marica Eoli
    • 14
  • Sara Gasparini
    • 2
  • Anna Teresa Giallonardo
    • 15
  • Angela La Neve
    • 16
  • Andrea Maialetti
    • 1
  • Oriano Mecarelli
    • 17
  • Marta Melis
    • 18
  • Roberto Michelucci
    • 19
  • Francesco Paladin
    • 20
  • Giada Pauletto
    • 21
  • Marta Piccioli
    • 22
  • Stefano Quadri
    • 23
  • Federica Ranzato
    • 24
  • Rosario Rossi
    • 25
  • Andrea Salmaggi
    • 26
  • Riccardo Terenzi
    • 27
  • Paolo Tisei
    • 28
  • Flavio Villani
    • 29
  • Paolo Vitali
    • 30
  • Lucina Carla Vivalda
    • 31
  • Gaetano Zaccara
    • 32
  • Alessia Zarabla
    • 1
  • Ettore Beghi
    • 33
  • On behalf of Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE)
  1. 1.Center for Brain Tumor-Related Epilepsy, UOSD Neuro-OncologyI.R.C.C.S. Regina Elena National Cancer InstituteRomeItaly
  2. 2.Department of Medical and Surgical SciencesMagna Graecia University of CatanzaroCatanzaroItaly
  3. 3.Department of Neurophysiology and Experimental EpileptologyCarlo Besta Neurological InstituteMilanItaly
  4. 4.Neurology Unit, Department of Emergency, Medicine Epilepsy CenterCircolo HospitalVareseItaly
  5. 5.Department of Neuroscience, Mental Health and Sensory OrgansUniversity of Rome “La Sapienza”RomeItaly
  6. 6.Department of Mental Health, Epilepsy CenterC. Poma HospitalMantuaItaly
  7. 7.Neurophysiopatology Unit, Fondazione IRCCSIstituto Neurologico C. BestaMilanItaly
  8. 8.Institute of NeurosurgeryCatholic University of the Sacred HeartRomeItaly
  9. 9.Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy CentreUniversity of Naples Federico IINaplesItaly
  10. 10.Neurological Clinic, Department of Medicine, Santa Maria della Misericordia HospitalUniversity of PerugiaPerugiaItaly
  11. 11.Epilepsy Centre, UOC NeurologySS. Giovanni e Paolo HospitalVeniceItaly
  12. 12.Epilepsy Center-U.O.C. Neurology, Policlinico Paolo Giaccone, Experimental Biomedicine and Clinical Neuroscience Department (BioNeC)University of PalermoPalermoItaly
  13. 13.Neurology and Stroke Unit, Epilepsy and Sleep Disorders CenterSt. Eugenio HospitalRomeItaly
  14. 14.Molecular Neuro-Oncology UnitIRCCS-Fondazione Istituto Neurologico Carlo BestaMilanItaly
  15. 15.Neurology Unit, Human Neurosciences DepartmentSapienza UniversityRomeItaly
  16. 16.Department of Neurological and Psychiatric Sciences, Centre for EpilepsyUniversity of BariBariItaly
  17. 17.Neurology Unit, Human Neurosciences DepartmentSapienza UniversityRomeItaly
  18. 18.Department of Medical Sciences and Public Health, Institute of NeurologyUniversity of CagliariCagliariItaly
  19. 19.Unit of Neurology, Bellaria HospitalIRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
  20. 20.Epilepsy Center, UOC NeurologyOspedale Santi Giovanni e PaoloVeniceItaly
  21. 21.Department of NeurosciencesSanta Maria della Misericordia University HospitalUdineItaly
  22. 22.UOC NeurologyPO San Filippo NeriRomeItaly
  23. 23.USC Neurology, Epilepsy CenterASST Papa Giovanni XXIIIBergamoItaly
  24. 24.Epilepsy Centre, Neuroscience DepartmentS. Bortolo HospitalVicenzaItaly
  25. 25.Neurology and Stroke UnitSan Francesco HospitalNuoroItaly
  26. 26.Neurological DepartmentASSTLeccoItaly
  27. 27.Epilepsy Consultation Room, Neurology UnitS. Pietro Fatebenefratelli HospitalRomeItaly
  28. 28.Neurophysiology Unit, Department of Neurology-University “La Sapienza”S. Andrea HospitalRomeItaly
  29. 29.Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCSIstituto Neurologico C. BestaMilanItaly
  30. 30.Neuroradiology and Brain MRI 3T Mondino Research CenterIRCCS Mondino FoundationPaviaItaly
  31. 31.Epilepsy Consultation Room, U.O.C. NeurologyRivoli HospitalTurinItaly
  32. 32.Regional Health Agency of TuscanyFlorenceItaly
  33. 33.Department of NeurosciencesIRCCS Istituto di Ricerche Farmacologiche Mario NegriMilanItaly

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