Clinical Approach to Brain Tumor-Related Epilepsy

This chapter considers several important issues related to the care of patients with brain tumor-related epilepsy (BTRE), including prophylactic antiepileptic drugs (AEDs), choice of AEDs, potential interactions of AEDs with chemotherapy, optimizing the AED regimen, and driving with BTRE. In some patients with BTRE, AEDs are initiated before the patient has ever had a documented seizure, typically at the time of surgery, as part of a strategy called seizure prophylaxis. We review the literature regarding the prophylactic use of AEDs in detail. The current data has led to the consensus view that AED prophylaxis is not recommended and that AEDs should be started at the time of the first documented seizure. We also discuss the potential interactions between AEDs and chemotherapy, as well as how to choose an AED to optimize therapy. Issues related to BTRE and driving are also explored.