Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Curr Opin Neurol. 2010 Dec;23(6):603-9. doi: 10.1097/WCO.0b013e32833e996c.
This review focuses on anticonvulsant treatments in patients with brain tumors and epilepsy, in consideration of the rapidly expanding spectrum of these agents.
Despite the fact that this clinical condition is frequent, scarce evidence is available on this topic. Current American Association of Neurology practice parameters, published a decade ago, discourage the prescription of prophylactic anticonvulsant treatment; this should, however, be implemented after a first seizure in view of the high recurrence risk. Several observational series describe the use of newer anti-epileptic compounds in this clinical setting, suggesting that these should be preferred to traditional anticonvulsants in view of their safety regarding pharmacokinetic interactions and better tolerability. In particular, levetiracetam and pregabalin seem promising. Anti-epileptic treatment leads to a complete control or a marked reduction of seizures in most patients with brain tumors; however, there is currently no evidence that efficacy is different among all marketed anti-epileptic drugs.
Despite the lack of high-level evidence data, the use of anticonvulsants devoid of pharmacokinetic interactions should be recommended in patients with epilepsy symptomatic of brain tumors. Prospective, comparative studies are needed to address open questions regarding the role of specific agents and optimal treatment duration.
本综述重点关注脑瘤合并癫痫患者的抗癫痫治疗，同时考虑到这些药物的应用范围正在迅速扩大。
尽管这种临床情况很常见，但关于这一主题的证据很少。美国神经病学协会十年前发布的现行实践参数不鼓励预防性使用抗癫痫药物；然而，鉴于复发风险高，应在首次发作后实施这种治疗。一些观察性研究系列描述了在这种临床情况下使用新型抗癫痫药物，鉴于这些药物在药代动力学相互作用方面具有安全性且耐受性更好，建议将其用于传统抗癫痫药物。特别是左乙拉西坦和普瑞巴林似乎很有前景。在大多数脑瘤伴发癫痫的患者中，抗癫痫治疗可使癫痫完全控制或明显减少；然而，目前尚无证据表明所有市售抗癫痫药物的疗效存在差异。
尽管缺乏高级别证据数据，但应建议具有脑瘤症状的癫痫患者使用无药代动力学相互作用的抗癫痫药物。需要进行前瞻性、对照研究，以解决关于特定药物的作用和最佳治疗持续时间的开放性问题。
