Pace A, Bove L, Innocenti P, Pietrangeli A, Carapella C M, Oppido P, Raus L, Occhipinti E, Jandolo B
Neurology Service, Istituto Regina Elena, Rome, Italy.
J Exp Clin Cancer Res. 1998 Dec;17(4):479-82.
One hundred and nineteen consecutive patients affected by supratentorial gliomas were studied in order to determine the incidence of seizure at diagnosis, the occurrence of subsequent seizures and the efficacy of anticonvulsant treatment. The overall incidence of seizures as presentation symptom was 52% (62 patients). Preoperative seizures were present in 83% of patients affected by low-grade astrocytoma, in 46% of patients affected by anaplastic astrocytoma and in 36% of patients affected by glioblastoma. Postoperative epilepsy refractory to anticonvulsant treatment significantly related to low-grade histology and presence of preoperative seizures occurred in 48% of patients. Adverse effects associated with anticonvulsants were observed in 33.8% of patients treated with phenobarbital, 14.3% in the group treated with carbamazepine and 12% of patients treated with vigabatrin. We conclude that anticonvulsant treatment in patients affected by gliomas is often ineffective and prophylactic treatment should be discontinued after 6 months in patients preoperative seizures free. In patients with high risk of seizures antiepileptic drugs with good efficacy and lower incidence of adverse effects than phenobarbital are indicated.
对119例幕上胶质瘤患者进行了连续研究，以确定诊断时癫痫发作的发生率、后续癫痫发作的情况以及抗惊厥治疗的疗效。作为首发症状的癫痫发作总发生率为52%（62例患者）。低级别星形细胞瘤患者中83%存在术前癫痫发作，间变性星形细胞瘤患者中46%存在术前癫痫发作，胶质母细胞瘤患者中36%存在术前癫痫发作。抗惊厥治疗难治的术后癫痫与低级别组织学和术前癫痫发作显著相关，48%的患者出现这种情况。在接受苯巴比妥治疗的患者中，33.8%观察到与抗惊厥药物相关的不良反应，在接受卡马西平治疗的组中为14.3%，在接受氨己烯酸治疗的患者中为12%。我们得出结论，胶质瘤患者的抗惊厥治疗通常无效，术前无癫痫发作的患者在6个月后应停止预防性治疗。对于癫痫发作风险高的患者，应使用疗效好且不良反应发生率低于苯巴比妥的抗癫痫药物。
