Epilepsy in Neuro-Oncology: a review

with practical management approach

M. RIVA, V. BADIONI, M.G. PASCARELLA, S.A. SPERBER, E. DOMINA

Department of Neurology, ASST of Lodi, Italy

Summary

Progress in Neuroscience 2020; 5 (1-4): 11-24.

Seizures in oncologic patients represent an important clinical and social complication. Their
management needs considering several aspects, among which: (1) seizures recurrence and pharmacoresistance; (2) increased sensitivity to the adverse effects of antiepileptic drugs, (3) changes in clinical response in relation to the progression of the disease, (4) adverse interactions between antiepileptic drugs and chemotherapeutic agents. We can delineate three clinical scenarios in which seizures occur: (1) seizure or epilepsy in patients with a structural “active” neoplastic brain lesion(s) (primary or metastatic), strictly and commonly identified as “brain-tumour associated epilepsy”; (2) seizure or epilepsy in patients without an “active” neoplastic brain lesion, but expression of a structural lesion: peri/post-operative period for any other central nervous system oncologic surgery (e.g. oedema or haemorrhage in pituitary adenoma etc); vascular, paraneoplastic, treatment and infectious complications in systemic cancers; history of a previous central nervous system tumour but not expression of active neoplastic central nervous system disease (e.g. follow-up of meningioma etc); (3) Seizure or epilepsy in other various conditions of any cancer, toxicity of its treatments (mainly acute central nervous system radiotherapy); metabolic and treatment complications in systemic cancers etc. This paper addresses to physicians, in order to choose adequate management and pharmacologic approach in treatment of seizures associated with tumours. The present review refers only to adult patients..

KEY WORDS: Anticonvulsants, Brain tumours, Epilepsy, Systemic neoplasms, Treatment guidelines.

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