====== Brain tumor-related epilepsy ======

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===== Epidemiology =====


[[Brain tumor]]-related [[epilepsy]] (BTRE) is a common [[brain tumor complication]]  and its incidence is highly dependent on the type of tumor, ranging from 10-15% in [[brain metastases]] to > 80% in [[low-grade glioma]]s. About 5% of new epilepsy patients have a brain tumor, and a brain tumor causes about 10% of epilepsy with [[focal seizure]]s

===== Pathogenesis =====
Next to [[neuroinflammation]], findings on the pathogenesis have established that certain genetic mutations are involved, of which the most known would be IDH mutations in gliomas. Others discussed more thoroughly in the present review include genes such as PTEN, TP53, and IGSF3, and these findings all provide fresh and fascinating insights into the pathogenesis of BTRE
((Dantio CD, Fasoranti DO, Teng C, Li X. Seizures in brain tumors: pathogenesis, risk factors and management (Review). Int J Mol Med. 2025 May;55(5):82. doi: 10.3892/ijmm.2025.5523. Epub 2025 Mar 21. PMID: 40116082.))


===== Pathophysiology =====
Increasing knowledge about the pathophysiology of BTRE, particularly on glutamatergic mechanisms of [[oncogenesis]] and [[epileptogenesis]], might influence the management of anti-tumor and BTRE treatment in the future. The first [[seizure]] implies the [[epilepsy diagnosis]] in patients with [[brain tumor]]s. Due to the lack of [[prospective]] [[randomized trial]]s in BTRE, general [[recommendation]]s for [[focal epilepsy]] currently apply concerning the initiation of [[antiepileptic drug]]. Non-enzyme-inducing [[antiepileptic drug]] is preferable. [[Prospective]] [[trial]]s are needed to evaluate if [[AMPA]] [[inhibitor]]s like [[perampanel]] possess anti-tumor effects. [[antiepileptic drug]] withdrawal has to be weighed very carefully against the risk of [[seizure]] [[recurrence]], but can be achievable in selected patients. Permission to drive is possible for some patients with BTRE under well-defined conditions but requires thorough neurological, radiological, ophthalmological, and neuropsychological [[examination]].

Evolving knowledge of the [[pathophysiology]] of BTRE might influence future therapy. [[Randomized trial]]s on [[antiepileptic drug]] in [[Brain tumor-related epilepsy]] with reliable endpoints are needed. [[Management]] of [[withdrawal]] of [[antiepileptic drug]]s and permission to drive demands thorough diagnostic as well as neurooncological and epileptological [[expertise]]
((Seidel S, Wehner T, Miller D, Wellmer J, Schlegel U, Grönheit W. Brain tumor related epilepsy: pathophysiological approaches and rational management of antiseizure medication. Neurol Res Pract. 2022 Sep 5;4(1):45. doi: 10.1186/s42466-022-00205-9. PMID: 36059029.))

===== Treatment =====
[[Brain tumor-related epilepsy treatment]].