Brain Tumor-Related Epilepsy: a Current Review of the Etiologic Basis and Diagnostic and Treatment Approaches

Abstract

Purpose of review: The relationship of brain tumors and seizures remains poorly understood. This article is an overview of the epidemiology, etiology, and diagnostic and treatment approaches of tumor-related epilepsy primarily with regard to glial-based tumors, the most commonly considered brain tumor in this field.

Recent findings: Over the past many years, several novel etiologic mechanisms to explain how tumors induce seizures have been developed, which this article reviews, including the roles of glutamate-induced excitotoxicity, matrix metalloproteinases, isocitrate dehydrogenase, methylguanine methyltransferase, and functional network connectivity. As well, diagnostic and treatment approaches vary considerably. This article summarizes the evidence and provides the rationale for a reconsideration of how we deliver pre-operative, peri-operative, and post-operative care to these patients. Patients with brain tumors and epilepsy are a very challenging subgroup of patients, which necessitates not just a thorough understanding of the current principles regarding tumor-related epilepsy but also the development of collaborative research to advance our knowledge even further, and a concerted effort to develop a standardized, multi-disciplinary clinical approach to improve the care of these patients.

Keywords: Anti-epileptic drugs; Continuous EEG; Genetic biomarkers; Tumor resection; Tumor-related epilepsy.