Management of Seizures in Brain Tumour Patients

Chapter 12 - Anticoagulation and Management of Seizures and Brain Oedema in Brain Tumour Patients

Seizures are a common neurological complication in brain tumour patients. They may be the initial sign of a brain tumour or occur during the course of disease. Frequency of seizures varies between 30% and 100%, depending on the histology and site of the brain tumour.

Epileptogenesis in brain tumour patients is multifactorial. Site of the tumour, destruction of neuronal tissue and networks, haemosiderin deposition, necrosis, oedema, tumour-induced neurochemical changes, as well as treatment-related complications are the major contributing factors.

Seizures as well as possible side effects from anticonvulsants may affect the patient’s neurological function and quality of life. Moreover, anticonvulsant-related adverse events are more frequent in patients with brain tumours versus patients with epilepsy due to other causes.

Treatment recommendations for antiepileptic drugs in brain tumour patients are in line with general guidelines for treating epilepsy. 

However, antiepileptic drugs with low potential for side effects, without hepatic Enzyme induction, low plasma protein binding, and predominant renal excretion should primarily be considered.

Up to 70% of patients can achieve seizure freedom by using anticonvulsants, at least in gliomas. The efficacy of treatment strongly depends on the type and location of the tumour, as well as on antitumour treatment, anticonvulsants used and type of seizure (simple partial seizures are associated with less favourable control). Accordingly, multiple treatment strategies have to be considered. Surgery, radiotherapy and chemotherapy may contribute to seizure control.

Recommendations for diagnostic procedures and follow-up of brain tumour patients with seizures are: a seizure-tracking calendar and interviewing patients and their relatives for possible seizure equivalents. An electroencephalogram (EEG) might be helpful in some cases to detect or monitor seizure activity. In case of an increase in the seizure frequency or a change in the type of seizures, tumour recurrence or progression must be ruled out.

Stopping anticonvulsant therapy may be considered in patients with stable brain tumour disease over time, without seizure activity in the EEG and seizure freedom. A slow tapering of anticonvulsants is required.

Revision Questions

  1. Brain tumour patients frequently suffer from seizures. The probability of having seizures depends on what factors?
  2. What are the treatment options for tumour-associated seizures?
  3. Which drugs are recommended for anticonvulsant treatment?

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Last update: 18 September 2017