Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Nov 1;34(6):685-690.
doi: 10.1097/CCO.0000000000000876. Epub 2022 Jul 16.

Management of epilepsy in brain tumor patients

Pim B van der Meer  1 , Martin J B Taphoorn  1   2 , Johan A F Koekkoek  1   2
Affiliations
Review

Management of epilepsy in brain tumor patients

Pim B van der Meer et al. Curr Opin Oncol. .

Abstract

Purpose of review: A concise review of recent findings in brain tumor-related epilepsy (BTRE), with focus on the effect of antitumor treatment on seizure control and the management of antiepileptic drugs (AEDs).

Recent findings: Isocitrate dehydrogenase mutation and its active metabolite d -2-hydroxyglutarate seem important contributing factors to epileptogenesis in BTRE. A beneficial effect of antitumor treatment (i.e. surgery, radiotherapy, and chemotherapy) on seizure control has mainly been demonstrated in low-grade glioma. AED prophylaxis in seizure-naïve BTRE patients is not recommended, but AED treatment should be initiated after a first seizure has occurred. Comparative efficacy randomized controlled trials (RCTs) are currently lacking, but second-generation AED levetiracetam seems the preferred choice in BTRE. Levetiracetam lacks significant drug-drug interactions, has shown favorable efficacy compared to valproic acid in BTRE, generally causes no hematological or neurocognitive functioning adverse effects, but caution should be exercised with regard to psychiatric adverse effects. Potential add-on AEDs in case of uncontrolled seizures include lacosamide, perampanel, and valproic acid. Ultimately, in the end-of-life phase when oral intake of medication is hampered, benzodiazepines via nonoral administration routes are potential alternatives.

Summary: Management of seizures in BTRE is complex and with currently available evidence levetiracetam seems the preferred choice. Comparative efficacy RCTs in BTRE are warranted.

Trial registration: ClinicalTrials.gov NCT03048084.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Box 1
Box 1
no caption available
See this image and copyright information in PMC

References

    1. Fisher RS, van Emde Boas W, Blume W, et al. . Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005; 46:470–472. - PubMed
    1. Fisher RS, Acevedo C, Arzimanoglou A, et al. . ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55:475–482. - PubMed
    1. Armstrong TS, Grant R, Gilbert MR, et al. . Epilepsy in glioma patients: mechanisms, management, and impact of anticonvulsant therapy. Neuro-oncology 2016; 18:779–789. - PMC - PubMed
    1. van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 2007; 6:421–430. - PubMed
    1. Phan K, Ng W, Lu VM, et al. . Association between IDH1 and IDH2 mutations and preoperative seizures in patients with low-grade versus high-grade glioma: a systematic review and meta-analysis. World Neurosurg 2018; 111:e539–e545. - PubMed

MeSH terms

Associated data