Seizure management in patients with gliomas

Abstract

Seizures represent a major cause of morbidity in patients diagnosed with brain tumors. Seizures in patients with gliomas are disruptive, impact on quality of life; autonomy; the capacity to operate motor vehicles and opportunities for work. The management of seizures in patients with brain tumors is complex and ideally managed in a multidisciplinary fashion. In addition to antiepileptic drugs, surgery, chemotherapy and radiotherapy have potential roles in the management of a glioma patient with intractable epilepsy. The successful management of seizures in patients with brain tumors is possible, it provides considerable benefits in terms of quality of life and should remain a central goal in patient management.

Keywords::

• brain tumor
• glioma
• neurology
• seizure
• therapy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Seizures represent the most frequent presentation of low-grade gliomas. They can be a sign of tumor progression if seizures worsen or change in morphology after a period of stability.

• The choice of an antiepileptic drug (AED) must be individualized and is influenced by patient comorbidities and drug side effect profiles. Monotherapy is a therapeutic ideal as a means of minimizing toxicities.

• The American Academy of Neurology Practice Parameters recommends against prophylactic anticonvulsants for brain tumor patients without a history of seizures who have not undergone surgery within 1 week.

• Gross total tumor resection of tumor remains the strongest predictor of seizure freedom at 6 months postsurgery.

• Gamma knife radiosurgery can improve seizure control for selected patients with gliomas and refractory epilepsy. Stereotactic radiotherapy can improve seizure control for patients with unresectable gliomas.

• The use of alkylating agents, including temozolomide, can improve seizure control in patients with gliomas.

• Carefully selected brain tumor patients only with a history of remote seizures may be candidates for discontinuation of AEDs.

• Enzyme-inducing AEDs affect the plasma concentration of dexamethasone, antineoplastic agents and other anticonvulsants. However, temozolomide does not undergo hepatic metabolism and is not affected by enzyme-inducing AEDs.

• Valproic acid may possess anticancer properties via its potent inhibitory effect on histone deacetylase. Studies evaluating this attribute are ongoing in patients with primary brain tumors.