Management of epilepsy in brain tumors

Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE)

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalNeurological Sciences
DOIs
Publication statusE-pub ahead of print - Aug 7 2019

Fingerprint

Brain Neoplasms
Anticonvulsants
Epilepsy
etiracetam
Patient Advocacy
Valproic Acid
Therapeutics
Pharmaceutical Preparations
Antineoplastic Agents
Electroencephalography
Neoplasms
Seizures
Guidelines
Enzymes

Cite this

Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE) (2019). Management of epilepsy in brain tumors. Neurological Sciences. https://doi.org/10.1007/s10072-019-04025-9

Management of epilepsy in brain tumors. / Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE).

In: Neurological Sciences, 07.08.2019.

Research output: Contribution to journalArticle

Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE) 2019, 'Management of epilepsy in brain tumors', Neurological Sciences. https://doi.org/10.1007/s10072-019-04025-9
Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE). Management of epilepsy in brain tumors. Neurological Sciences. 2019 Aug 7. https://doi.org/10.1007/s10072-019-04025-9
Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE). / Management of epilepsy in brain tumors. In: Neurological Sciences. 2019.
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abstract = "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.",
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AU - Banfi, Paola

AU - Buttinelli, Carla

AU - Capovilla, Giuseppe

AU - Casazza, Marina Maria Luisa

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AU - Coppola, Antonietta

AU - Costa, Cinzia

AU - Dainese, Filippo

AU - Daniele, Ornella

AU - De Simone, Roberto

AU - Eoli, Marica

AU - Gasparini, Sara

AU - Giallonardo, Anna Teresa

AU - La Neve, Angela

AU - Maialetti, Andrea

AU - Mecarelli, Oriano

AU - Melis, Marta

AU - Michelucci, Roberto

AU - Paladin, Francesco

AU - Pauletto, Giada

AU - Piccioli, Marta

AU - Quadri, Stefano

AU - Ranzato, Federica

AU - Rossi, Rosario

AU - Salmaggi, Andrea

AU - Terenzi, Riccardo

AU - Tisei, Paolo

AU - Villani, Flavio

AU - Vitali, Paolo

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