Dupont S
Unité d'épileptologie, clinique neurologique Paul-Castaigne, hôpital de la Salpêtrière, 47, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Rev Neurol (Paris). 2008 Jun-Jul;164(6-7):517-22. doi: 10.1016/j.neurol.2008.03.016. Epub 2008 Jun 4.
Epilepsy is common in patients with brain tumors. Usually, an epileptic seizure is the presenting sign of the cerebral lesion but late seizures may also occur. The tumors type and their locations are determining factors that significantly influence seizure frequency. Brain tumors with a high risk for epilepsy are developmental tumors, slow-growing tumors (low-grade gliomas), hemorrhagic tumors and multiple metastases. Seizures associated with brain tumors are sometimes difficult to treat. This relative drug-resistance may be attributed to several factors: the tumor development, modifications of tumor and peritumor tissues, oncologic treatments. Genetic factors also play an important role and multidrug-resistance proteins associated with brain tumors can be a major cause of epilepsy refractoriness. The choice of the antiepileptic treatment is very important and must take into account individual factors but, in general, the first-line prescription of enzyme-inducing antiepileptic drugs, especially phenytoin, is not mandatory. Given the frequency of epilepsy in patients with brain tumors, a prophylactic antiepileptic treatment could be warranted; but, unfortunately, no study has proven the effect of antiepileptic drugs as prophylactic treatment and a consensus statement from the AAN recommends not using antiepileptic drugs routinely as prophylaxis in patients with brain tumors. Nevertheless, these recommendations are based on studies performed with conventional antiepileptic drugs. Further randomized large cohort studies seem thus required to assess the effectiveness of new antiepileptic drugs to prevent and cure epilepsy in patients with brain tumors.
癫痫在脑肿瘤患者中很常见。通常，癫痫发作是脑部病变的首发症状，但也可能出现晚期发作。肿瘤类型及其位置是显著影响癫痫发作频率的决定性因素。癫痫风险高的脑肿瘤包括发育性肿瘤、生长缓慢的肿瘤（低级别胶质瘤）、出血性肿瘤和多发转移瘤。与脑肿瘤相关的癫痫发作有时难以治疗。这种相对耐药性可能归因于几个因素：肿瘤发展、肿瘤及肿瘤周围组织的改变、肿瘤治疗。遗传因素也起重要作用，与脑肿瘤相关的多药耐药蛋白可能是癫痫难治的主要原因。抗癫痫治疗的选择非常重要，必须考虑个体因素，但一般来说，酶诱导型抗癫痫药物尤其是苯妥英钠的一线处方并非强制要求。鉴于脑肿瘤患者癫痫的发生率，预防性抗癫痫治疗可能是必要的；但遗憾的是，尚无研究证实抗癫痫药物作为预防性治疗的效果，美国神经病学学会的一份共识声明建议，对于脑肿瘤患者，不要常规使用抗癫痫药物进行预防。然而，这些建议是基于使用传统抗癫痫药物进行的研究。因此，似乎需要进一步开展随机大队列研究，以评估新型抗癫痫药物预防和治疗脑肿瘤患者癫痫的有效性。
