Management of epilepsy in brain tumors

Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE), Marta Maschio, 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 MecarelliMarta 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

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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 languageItalian
Pages (from-to)2217-2234
JournalNeurol. Sci.
Publication statusPublished - Aug 7 2019

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