====== Brain tumor-related epilepsy treatment ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1zqXPI1EmDrw_5XIRW_bBUR9W6zTayCKcGjCcLpdDJgBQv1kUs/?limit=15&utm_campaign=pubmed-2&fc=20250321181851}} ---- ---- Brain Tumor-Related Epilepsy (BTRE) requires a [[multidisciplinar]]y approach, combining **neurosurgery**, **antiepileptic drugs (AEDs)**, and **oncologic therapies** depending on tumor type and patient profile. ---- Management of seizures in BTRE is complex and with currently available evidence [[levetiracetam]] seems the preferred choice. Comparative efficacy RCTs in BTRE are warranted ((van der Meer PB, Taphoorn MJB, Koekkoek JAF. Management of epilepsy in brain tumor patients. Curr Opin Oncol. 2022 Nov 1;34(6):685-690. doi: 10.1097/CCO.0000000000000876. Epub 2022 Jul 16. PMID: 35838207; PMCID: PMC9594141.)) Future studies should consider the use of a standardized method of seizure tracking and incorporating seizure outcomes as a primary endpoint of tumor treatment trials ((Avila, E. K., Tobochnik, S., Inati, S. K., Koekkoek, J. A., McKhann, G. M., Riviello, J. J., Rudà, R., Schiff, D., Tatum, W. O., Templer, J. W., Weller, M., & Wen, P. Y. (2024). Brain tumor-related epilepsy management: A Society for Neuro-oncology (SNO) consensus review on current management. Neuro-Oncology, 26(1), 7-24. https://doi.org/10.1093/neuonc/noad154)) An evolving knowledge of the pathophysiology of BTRE might influence future therapy. Management of withdrawal of ASMs 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; PMCID: PMC9442934.)). ===== 🧠 1. Surgical Treatment ===== * **Goal**: Remove the tumor to reduce both mass effect and seizure focus. * **Efficacy**: Surgery can lead to seizure freedom in up to **80%** of cases with gross total resection. * **Techniques**: * Neuronavigation and intraoperative monitoring (ECoG, awake surgery). * Supratotal resection may be beneficial in low-grade gliomas. ===== 💊 2. Antiepileptic Drugs (AEDs) ===== see [[Antiepileptic Drugs for Brain tumor-related epilepsy treatment]] ===== ☢️ 3. Oncologic Therapies ===== * **Radiation Therapy**: * Controls tumor growth, may indirectly reduce seizure burden. * **Chemotherapy**: * Temozolomide (especially in glioblastoma) may help reduce seizures over time. ===== 🔄 4. Multimodal Considerations ===== * **Tumor type** matters: * Low-grade gliomas and DNETs are highly epileptogenic. * **Epileptogenic zone**: * May extend beyond visible tumor → requires mapping. * **Teamwork**: * Requires coordination between neuro-oncology, neurosurgery, and epileptology teams. ===== 🧩 5. Emerging and Adjunct Therapies ===== * **Neurostimulation**: * VNS, RNS for drug-resistant BTRE. * **Ketogenic diet**: * Occasionally used in refractory epilepsy. * **AI and precision medicine**: * Tools under development for seizure prediction and individualized therapy. ===== 🧠 Summary Table ===== ^ Treatment ^ Goal ^ Notes ^ | Surgery | Tumor + seizure control | Highest chance of seizure freedom | | AEDs | Symptom control | Levetiracetam is first-line | | Radiotherapy/Chemo | Tumor control | May improve seizure control long-term | | Multidisciplinary approach | Optimize outcomes | Epileptologist + neurosurgeon + oncologist | ---- Treatment for [[Brain tumor-related epilepsy]] presents unique challenges, mainly related to burdens of [[polytherapy]], debated necessity of anti‑epileptic [[prophylaxis]], and overall impact on the [[QoL]]. There are no established protocols to guide the use of these medications at every step of disease progression. Treatment strategies aimed at the tumor, that is surgical procedures, radio‑ and chemotherapy appear to influence seizure control. Conversely, some [[antiepileptic drug]]s have also shown antitumor properties ((Dantio CD, Fasoranti DO, Teng C, Li X. [[Seizure]]s in [[brain tumor]]s: [[pathogenesis]], [[risk factor]]s and [[management]] ([[Review]]). Int J Mol Med. 2025 May;55(5):82. doi: 10.3892/ijmm.2025.5523. Epub 2025 Mar 21. PMID: 40116082.)) ---- Patients with [[brain tumor]]-associated [[seizure]]s need treatment with [[antiepileptic drug]]s (AEDs) to prevent a recurrence, whereas strong clinical data exists to discourage routine prophylaxis in patients who have not had seizures. The newer AEDs, such as [[levetiracetam]], lamotrigine, lacosamide, topiramate, or pregabalin, are preferable for various reasons, primarily related to the side-effect profile and limited interactions with other drugs. If seizures persist despite the initiation of an appropriate monotherapy (in up to 30-40% of cases), additional anticonvulsants may be necessary. Early surgical intervention improves seizure outcomes in individuals with medically refractory epilepsy, especially in patients with a single lesion that is epileptogenic. Data for this review article were compiled by searching for scholarly articles using the following keywords: a brain tumor, epilepsy, seizure, tumor-related epilepsy, central nervous system, epidemiology, review, clinical trial, and surgery. Articles were screened for relevance by title and abstract and selected for review and inclusion based on significant contribution to the topics discussed ((Klinger NV, Shah AK, Mittal S. Management of brain tumor-related epilepsy. Neurol India. 2017;65(Supplement):S60-S70. doi: 10.4103/neuroindia.NI_1076_16. PMID: 28281497.)).