Pathogenesis and Management of Brain Tumor-Related Epilepsy

Excerpt

Up to 50% of patients with brain tumors will initially present with seizures, while an additional 10–30% will develop seizures during the course of the disease. Gliomas are the most common primary intracranial tumors and are associated with a number of changes which are involved in the pathogenesis of epilepsy, including blood-brain barrier disruption, molecular changes, edema, and peritumoral environmental changes. Epilepsy is a source of significant morbidity and mortality for patients with gliomas. The two main treatments for patients with glioma-related epilepsy involve antiepileptic drugs as well as surgical resection of the mass and surrounding epileptogenic tissue, if feasible. Given the propensity for neighboring tissue to also be epileptogenic, intraoperative electrocorticography can be of benefit to define the seizure onset and spread areas. Surgical treatment of glioma-associated epilepsy can provide significant relief for affected patients. Unlike non-lesional epilepsy, which is primarily managed medically, glioma-related epilepsy frequently requires surgery because of its medically refractory nature.