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Review
. 2024 Jan 5;26(1):7-24.
doi: 10.1093/neuonc/noad154.

Brain tumor-related epilepsy management: A Society for Neuro-oncology (SNO) consensus review on current management

Edward K Avila  1 , Steven Tobochnik  2   3 , Sara K Inati  4 , Johan A F Koekkoek  5   6 , Guy M McKhann  7 , James J Riviello  8 , Roberta Rudà  9 , David Schiff  10 , William O Tatum  11 , Jessica W Templer  12 , Michael Weller  13 , Patrick Y Wen  14
Affiliations
Review

Brain tumor-related epilepsy management: A Society for Neuro-oncology (SNO) consensus review on current management

Edward K Avila et al. Neuro Oncol. .

Abstract

Tumor-related epilepsy (TRE) is a frequent and major consequence of brain tumors. Management of TRE is required throughout the course of disease and a deep understanding of diagnosis and treatment is key to improving quality of life. Gross total resection is favored from both an oncologic and epilepsy perspective. Shared mechanisms of tumor growth and epilepsy exist, and emerging data will provide better targeted therapy options. Initial treatment with antiseizure medications (ASM) in conjunction with surgery and/or chemoradiotherapy is typical. The first choice of ASM is critical to optimize seizure control and tolerability considering the effects of the tumor itself. These agents carry a potential for drug-drug interactions and therefore knowledge of mechanisms of action and interactions is needed. A review of adverse effects is necessary to guide ASM adjustments and decision-making. This review highlights the essential aspects of diagnosis and treatment of TRE with ASMs, surgery, chemotherapy, and radiotherapy while indicating areas of uncertainty. Future studies should consider the use of a standardized method of seizure tracking and incorporating seizure outcomes as a primary endpoint of tumor treatment trials.

Keywords: antiseizure medication; brain tumor; epilepsy; glioma; seizure.

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Conflict of interest statement

Dr. Avila—honoraria from UpToDate. Dr. Tobochnik—research support from Eisai. Dr. Inati—no conflicts to report. Dr. Koekkoek—no conflicts to report. Dr. McKhann—receives funding from Citizens United for Research in Epilepsy (CURE). Dr. Riviello—no conflicts to report. Dr. Ruda—no conflicts to report. Dr. Schiff—no conflicts to report. Dr. Tatum—receives research support from Mayo Clinic, Esai Inc, Liva Nova, Martin Family Foundation, McElvey Foundation. Patents held or pending: #62527896; #62770362 (intraoperative monitoring sensor devices. Dr. Templer—no conflicts to report. Dr. Weller—has received research grants from Quercis and Versameb, and honoraria for lectures or advisory board participation or consulting from Bayer, Curevac, Medac, Novartis, Novocure, Orbus, Philogen, Roche, and Sandoz. Dr. Wen—Research Support—Astra Zeneca, Black Diamond, Bristol Meyers Squibb, Celgene, Chimerix, Eli Lily, Erasca, Genentech/Roche, Kazia, MediciNova, Merck, Novartis, Nuvation Bio, Servier, Vascular Biogenics, VBI Vaccines. Advisory Board/Consultant -Astra Zeneca, Black Diamond, Celularity, Chimerix, Day One Bio, Genenta, Glaxo Smith Kline, Merck, Mundipharma, Novartis, Novocure, Nuvation Bio, Prelude Therapeutics, Sapience, Servier, Sagimet, Vascular Biogenics, VBI Vaccines.

Figures

Figure 1.
Figure 1.
Representative example of increasing seizure frequency aligning with tumor progression in a patient with recurrent oligodendroglioma despite ASM changes. CBM, cenobamate; LCM, lacosamide; LEV, levetiracetam; OXC, oxcarbazepine.
Figure 2.
Figure 2.
Schematic representation of established mechanisms underlying glioma-related epilepsy. Glutamatergic signaling is a key pathway affected and contributes to the development of functional neuron-glioma synapses. ASMs with selective mechanisms of action are shown. Created with BioRender.com.
Figure 3.
Figure 3.
Summary of hepatic CYP isoform abundance and selected oncology and epilepsy-related substrates, inhibitors, and inducers. Only major CYP substrates are included (Lexicomp). ASMs are shown in red. Adapted from Fink & Deo, Handbook of Brain Tumor Chemotherapy, Molecular Therapeutics, and Immunotherapy.
Figure 4.
Figure 4.
Proposed algorithm for ASM selection in glioma-related epilepsy. In polytherapy, ASMs with different mechanisms of action should be chosen to minimize adverse effects.
See this image and copyright information in PMC

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