Management of epilepsy in brain tumors

Marta Maschio¹, Umberto Aguglia², Giuliano Avanzini³, Paola Banfi⁴, Carla Buttinelli⁵, Giuseppe Capovilla⁶, Marina Maria Luisa Casazza⁷, Gabriella Colicchio⁸, Antonietta Coppola⁹, Cinzia Costa¹⁰, Filippo Dainese¹¹, Ornella Daniele¹², Roberto De Simone¹³, Marica Eoli¹⁴, Sara Gasparini², Anna Teresa Giallonardo¹⁵, Angela La Neve¹⁶, Andrea Maialetti¹⁷, Oriano Mecarelli¹⁸, Marta Melis¹⁹, Roberto Michelucci²⁰, Francesco Paladin²¹, Giada Pauletto²², Marta Piccioli²³, Stefano Quadri²⁴, Federica Ranzato²⁵, Rosario Rossi²⁶, Andrea Salmaggi²⁷, Riccardo Terenzi²⁸, Paolo Tisei²⁹, Flavio Villani³⁰, Paolo Vitali³¹, Lucina Carla Vivalda³², Gaetano Zaccara³³, Alessia Zarabla¹⁷, Ettore Beghi³⁴; Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE)

Affiliations

¹ Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. marta.maschio@ifo.gov.it.
² Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
³ Department of Neurophysiology and Experimental Epileptology, Carlo Besta Neurological Institute, Milan, Italy.
⁴ Neurology Unit, Department of Emergency, Medicine Epilepsy Center, Circolo Hospital, Varese, Italy.
⁵ Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy.
⁶ Department of Mental Health, Epilepsy Center, C. Poma Hospital, Mantua, Italy.
⁷ Neurophysiopatology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy.
⁸ Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.
⁹ Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy.
¹⁰ Neurological Clinic, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
¹¹ Epilepsy Centre, UOC Neurology, SS. Giovanni e Paolo Hospital, Venice, Italy.
¹² Epilepsy Center-U.O.C. Neurology, Policlinico Paolo Giaccone, Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy.
¹³ Neurology and Stroke Unit, Epilepsy and Sleep Disorders Center, St. Eugenio Hospital, Rome, Italy.
¹⁴ Molecular Neuro-Oncology Unit, IRCCS-Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁵ Neurology Unit, Human Neurosciences Department, Sapienza University, Rome, Italy.
¹⁶ Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy.
¹⁷ Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
¹⁸ Neurology Unit, Human Neurosciences Department, Sapienza University, Umberto 1 Hospital, Rome, Italy.
¹⁹ Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, Monserrato, Cagliari, Italy.
²⁰ Unit of Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
²¹ Epilepsy Center, UOC Neurology, Ospedale Santi Giovanni e Paolo, Venice, Italy.
²² Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
²³ UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy.
²⁴ USC Neurology, Epilepsy Center, ASST Papa Giovanni XXIII, Bergamo, Italy.
²⁵ Epilepsy Centre, Neuroscience Department, S. Bortolo Hospital, Vicenza, Italy.
²⁶ Neurology and Stroke Unit, San Francesco Hospital, 08100, Nuoro, Italy.
²⁷ Neurological Department, ASST, Lecco, Italy.
²⁸ Epilepsy Consultation Room, Neurology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
²⁹ Neurophysiology Unit, Department of Neurology-University "La Sapienza", S. Andrea Hospital, Rome, Italy.
³⁰ Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy.
³¹ Neuroradiology and Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy.
³² Epilepsy Consultation Room, U.O.C. Neurology, Rivoli Hospital, Turin, Italy.
³³ Regional Health Agency of Tuscany, Via P Dazzi 1, 50141, Florence, Italy.
³⁴ Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.

PMID: 31392641
DOI: 10.1007/s10072-019-04025-9

Practice Guideline

Management of epilepsy in brain tumors

Marta Maschio et al. Neurol Sci. 2019 Oct.

. 2019 Oct;40(10):2217-2234.

doi: 10.1007/s10072-019-04025-9. Epub 2019 Aug 7.

Authors

Affiliations

¹ Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. marta.maschio@ifo.gov.it.
² Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
³ Department of Neurophysiology and Experimental Epileptology, Carlo Besta Neurological Institute, Milan, Italy.
⁴ Neurology Unit, Department of Emergency, Medicine Epilepsy Center, Circolo Hospital, Varese, Italy.
⁵ Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy.
⁶ Department of Mental Health, Epilepsy Center, C. Poma Hospital, Mantua, Italy.
⁷ Neurophysiopatology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy.
⁸ Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.
⁹ Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy.
¹⁰ Neurological Clinic, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
¹¹ Epilepsy Centre, UOC Neurology, SS. Giovanni e Paolo Hospital, Venice, Italy.
¹² Epilepsy Center-U.O.C. Neurology, Policlinico Paolo Giaccone, Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy.
¹³ Neurology and Stroke Unit, Epilepsy and Sleep Disorders Center, St. Eugenio Hospital, Rome, Italy.
¹⁴ Molecular Neuro-Oncology Unit, IRCCS-Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁵ Neurology Unit, Human Neurosciences Department, Sapienza University, Rome, Italy.
¹⁶ Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy.
¹⁷ Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
¹⁸ Neurology Unit, Human Neurosciences Department, Sapienza University, Umberto 1 Hospital, Rome, Italy.
¹⁹ Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, Monserrato, Cagliari, Italy.
²⁰ Unit of Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
²¹ Epilepsy Center, UOC Neurology, Ospedale Santi Giovanni e Paolo, Venice, Italy.
²² Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
²³ UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy.
²⁴ USC Neurology, Epilepsy Center, ASST Papa Giovanni XXIII, Bergamo, Italy.
²⁵ Epilepsy Centre, Neuroscience Department, S. Bortolo Hospital, Vicenza, Italy.
²⁶ Neurology and Stroke Unit, San Francesco Hospital, 08100, Nuoro, Italy.
²⁷ Neurological Department, ASST, Lecco, Italy.
²⁸ Epilepsy Consultation Room, Neurology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
²⁹ Neurophysiology Unit, Department of Neurology-University "La Sapienza", S. Andrea Hospital, Rome, Italy.
³⁰ Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy.
³¹ Neuroradiology and Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy.
³² Epilepsy Consultation Room, U.O.C. Neurology, Rivoli Hospital, Turin, Italy.
³³ Regional Health Agency of Tuscany, Via P Dazzi 1, 50141, Florence, Italy.
³⁴ Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.

PMID: 31392641
DOI: 10.1007/s10072-019-04025-9

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.

Keywords: Antiepileptic drugs; Brain tumors; Epilepsy; Interaction; Quality of life; Side effects.

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References

1. Neurology. 2000 May 23;54(10):1886-93 - PubMed
1. J Neurooncol. 2000 Jul;48(3):249-50 - PubMed
1. Ann Oncol. 2001 Feb;12(2):217-9 - PubMed
1. Neurol India. 2001 Mar;49(1):55-9 - PubMed
1. Epilepsia. 2001 Apr;42(4):464-75 - PubMed

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Management of epilepsy in brain tumors

Affiliations

Management of epilepsy in brain tumors

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Medical