Summary and Further Reading

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

Summary

  • Adequate symptom palliation is beneficial for the quality of life of patients and their caregivers
  • The most frequent brain tumour symptoms besides neurological deficits are brain oedema, epileptic seizures and thromboembolic events
  • Effective anti-tumoural treatment is the best defence against tumour-related complications, but is not always achievable
  • Only patients with symptomatic oedema require treatment
  • Oral dexamethasone is still the most used treatment against symptomatic brain oedema, given prophylactically during the perisurgical period and at initiation of radiotherapy (starting dose 8–16 mg/day)
  • Due to its heavy side effect burden, as soon as no further symptomatic improvement is reached, dexamethasone dose should be reduced by half and further tapering should be tried
  • Thromboembolic events: general prophylaxis is not recommended outside the perisurgical period
  • Treatment of symptomatic thromboses can be safely done using LMWH; after six months an individual decision for further prophylaxis must be made. However, as the risk for recurrence in brain tumour patients is high, lifelong prophylaxis has to be considered
  • Seizures are a frequent complication in patients with primary brain tumours. Prophylactic treatment is not recommended
  • For symptomatic treatment of patients with seizures, antiepileptic drugs with low potential for side effects, without hepatic Enzyme induction, low plasma protein binding, and predominant renal excretion (levetiracetam, lamotrigine, valproic acid, lacosamide, zonisamide, etc.) should primarily be considered

Further Reading

Batchelor TT, Reardon, DA, de Groot JF, et al. Antiangiogenic therapy for glioblastoma: current status and future prospects. Clin Cancer Res 2014; 20:5612–5619.

Japp A, Gielen GH, Becker AJ. Recent aspects of classification and epidemiology of epilepsy-associated tumors. Epilepsia 2013; 54(Suppl 9):5–11.

Kostaras X, Cusano F, Kline GA, et al. Use of dexamethasone in patients with high-grade glioma: a clinical practice guideline. Curr Oncol 2014; 21:e493–e503.

Nagelhus EA, Ottersen OP. Physiological roles of aquaporin-4 in brain. Physiol Rev 2013; 93:1543–1562.

Obermeier B, Daneman R, Ransohoff RM. Development, maintenance and disruption of the blood-brain barrier. Nat Med 2013; 19:1584–1596.

Perry JR. Thromboembolic disease in patients with high-grade glioma. Neuro Oncol 2012; 14(Suppl 4):iv73–iv80.

Simanek R, Vormittag R, Hassler M, et al. Venous thromboembolism and survival in patients with high-grade glioma. Neuro Oncol 2007; 9:89–95.

Thaler J, Ay C, Kaider A, et al. Biomarkers predictive of venous thromboembolism in patients with newly diagnosed high-grade gliomas. Neuro Oncol 2014; 16:1645–1651.

Van Breemen MSM, Wilms EB, Vecht CJ. Seizure control in brain tumors. Handb Clin Neurol 2012; 104:381–389.

Wolburg H, Noell S, Fallier-Becker P, et al. The disturbed blood-brain barrier in human glioblastoma. Mol Aspects Med 2012; 33:579–589.

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Last update: 18 September 2017