Abstract
Epilepsy surgery represents the main treatment option for epileptogenic brain tumors. Scalp video-electroencephalography (EEG) and magnetic resonance imaging (MRI) may suffice for defining lesional area and seizure-onset zone in discrete, surgically resectable lesions. The choice of timing for surgery requires a multidisciplinary evaluation, especially in children, when a "wait and see" approach is chosen. Discordant electroclinical and neuroimaging data and an ill-defined epileptogenic lesion require invasive investigations. A multimodal integrated approach may maximize the extent of resection while preserving cerebral function in the eloquent cortex. Radical removal of the tumor is the most important predictor of seizure freedom. Additional predictors include histopathology, age at surgery, duration of epilepsy, and seizure type. Patients with brain tumors are highly vulnerable in relation to the frequent drug-resistance of seizures, the potential interactions between antiepileptic drugs (AEDs) and chemotherapeutic agents (CMTs), and the risk of AED-related cognitive adverse events (24% higher than in the rest of the epilepsy population), in addition to brain damage resulting from tumor itself, surgery, and radiotherapy. No robust, randomized, controlled evidence supports the choice of AEDs for the treatment of seizures in patients with brain tumors. Newer AEDs have limited or no enzyme-inducing profile, prevalent renal excretion, lower plasma protein binding and, consequently, fewer interactions with CMTs. Enzymeinducing AEDs can lower serum levels of concomitantly administered CMTs. Class I evidence suggests that in patients with brain tumors who do not have a history of seizures, prophylactic use of AEDs is neutral or ineffective.
| Original language | English |
|---|---|
| Pages (from-to) | 84-90 |
| Number of pages | 7 |
| Journal | Epilepsia |
| Volume | 54 |
| Issue number | SUPPL. 9 |
| DOIs | |
| Publication status | Published - 2013 |
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Keywords
- Brain tumor
- Medical treatment
- Surgical treatment
- Tumor-related epilepsy
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
- Medicine(all)
Cite this
The medical and surgical treatment of tumoral seizures : Current and future perspectives. / Guerrini, Renzo; Rosati, Anna; Giordano, Flavio; Genitori, Lorenzo; Barba, Carmen.
In: Epilepsia, Vol. 54, No. SUPPL. 9, 2013, p. 84-90.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The medical and surgical treatment of tumoral seizures
T2 - Current and future perspectives
AU - Guerrini, Renzo
AU - Rosati, Anna
AU - Giordano, Flavio
AU - Genitori, Lorenzo
AU - Barba, Carmen
PY - 2013
Y1 - 2013
N2 - Epilepsy surgery represents the main treatment option for epileptogenic brain tumors. Scalp video-electroencephalography (EEG) and magnetic resonance imaging (MRI) may suffice for defining lesional area and seizure-onset zone in discrete, surgically resectable lesions. The choice of timing for surgery requires a multidisciplinary evaluation, especially in children, when a "wait and see" approach is chosen. Discordant electroclinical and neuroimaging data and an ill-defined epileptogenic lesion require invasive investigations. A multimodal integrated approach may maximize the extent of resection while preserving cerebral function in the eloquent cortex. Radical removal of the tumor is the most important predictor of seizure freedom. Additional predictors include histopathology, age at surgery, duration of epilepsy, and seizure type. Patients with brain tumors are highly vulnerable in relation to the frequent drug-resistance of seizures, the potential interactions between antiepileptic drugs (AEDs) and chemotherapeutic agents (CMTs), and the risk of AED-related cognitive adverse events (24% higher than in the rest of the epilepsy population), in addition to brain damage resulting from tumor itself, surgery, and radiotherapy. No robust, randomized, controlled evidence supports the choice of AEDs for the treatment of seizures in patients with brain tumors. Newer AEDs have limited or no enzyme-inducing profile, prevalent renal excretion, lower plasma protein binding and, consequently, fewer interactions with CMTs. Enzymeinducing AEDs can lower serum levels of concomitantly administered CMTs. Class I evidence suggests that in patients with brain tumors who do not have a history of seizures, prophylactic use of AEDs is neutral or ineffective.
AB - Epilepsy surgery represents the main treatment option for epileptogenic brain tumors. Scalp video-electroencephalography (EEG) and magnetic resonance imaging (MRI) may suffice for defining lesional area and seizure-onset zone in discrete, surgically resectable lesions. The choice of timing for surgery requires a multidisciplinary evaluation, especially in children, when a "wait and see" approach is chosen. Discordant electroclinical and neuroimaging data and an ill-defined epileptogenic lesion require invasive investigations. A multimodal integrated approach may maximize the extent of resection while preserving cerebral function in the eloquent cortex. Radical removal of the tumor is the most important predictor of seizure freedom. Additional predictors include histopathology, age at surgery, duration of epilepsy, and seizure type. Patients with brain tumors are highly vulnerable in relation to the frequent drug-resistance of seizures, the potential interactions between antiepileptic drugs (AEDs) and chemotherapeutic agents (CMTs), and the risk of AED-related cognitive adverse events (24% higher than in the rest of the epilepsy population), in addition to brain damage resulting from tumor itself, surgery, and radiotherapy. No robust, randomized, controlled evidence supports the choice of AEDs for the treatment of seizures in patients with brain tumors. Newer AEDs have limited or no enzyme-inducing profile, prevalent renal excretion, lower plasma protein binding and, consequently, fewer interactions with CMTs. Enzymeinducing AEDs can lower serum levels of concomitantly administered CMTs. Class I evidence suggests that in patients with brain tumors who do not have a history of seizures, prophylactic use of AEDs is neutral or ineffective.
KW - Brain tumor
KW - Medical treatment
KW - Surgical treatment
KW - Tumor-related epilepsy
UR - http://www.scopus.com/inward/record.url?scp=84894323563&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84894323563&partnerID=8YFLogxK
U2 - 10.1111/epi.12450
DO - 10.1111/epi.12450
M3 - Article
C2 - 24328879
AN - SCOPUS:84894323563
VL - 54
SP - 84
EP - 90
JO - Epilepsia
JF - Epilepsia
SN - 0013-9580
IS - SUPPL. 9
ER -