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Walter Fröscher, Timo Kirschstein and Johannes Rösche


Background. The lifetime risk of patients with brain tumors to have focal epileptic seizures is 10-100%; the risk depends on different histology. Specific guidelines for drug treatment of brain tumor-related seizures have not yet been established.

Aim. This review addresses the special aspects of antiepileptic drug (AED) therapy in brain tumor-related epilepsy.

Methods. We analyzed the literature up to December 2015.

Results. Based on current evidence the management of tumor-related seizures does not differ substantially from that applied to epilepsies from other etiologies. Therefore, the choice of an AED is based, above all, on tolerability and pharmacokinetic interactions with chemotherapeutic drugs. Levetiracetam is recommended by many authors as first-line therapy in brain tumor-related epilepsy. Due to the possibility of interactions, the combination of enzyme-inducing AEDs and chemotherapeutic drugs, is usually not recommended as a first choice. Currently there is no evidence that prophylactic prescription of long-term AEDs in brain tumor-patients who did not present with seizures is justified. Because of the high risk of recurrence, however, AED treatment should be strongly considered after a single brain tumor-related seizure. The decision to withdraw AEDs must carefully consider the risk of seizure recurrence.

Conclusion. At present levetiracetam is the preferred drug in brain tumor-related epilepsy, especially when drug interactions need to be avoided. In the future we hope to acquire more targeted drugs against this disorder by uncovering its pathogenesis.

Open access

Duncan Palka, Mahinda Yogarajah, Hannah R. Cock and Marco Mula

. Neurol., 2006, 59: 35–41. doi: 10.1002/ana.20685 Hindley D., Ali A., Robson C.: Diagnoses made in a secondary care “fits, faints, and funny turns” clinic . Arch. Dis. Child., 2006, 91: 214–218. doi: 10.1136/adc.2004.062455 MacDonald B.K., Cockerell O.C., Sander J.W., Shorvon S.D.: The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK . Brain, 2000, 123: 665–676. doi: 10.1093/brain/123.4.665 Mellers J.D.C.: The approach to patients with ‘non-epileptic seizures’ . Postgrad. Med. J., 2005

Open access

Lukas Rasulic

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