Center for Tumor-related Epilepsy, Neurology Unit, Department of Neuroscience and Cervical-facial Pathology, National Institute for Cancer Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy.
Neurol Sci. 2011 Nov;32 Suppl 2:S259-62. doi: 10.1007/s10072-011-0801-3.
In patients with brain tumor, seizures are the onset symptom in 20-40% of the patients, while a further 20-45% of the patients will present them during the course of the disease. These data are important when considering the choice of antiepileptic drugs for this particular patient population, because brain tumor-related epilepsy (BTRE) is often drug resistant, has a strong impact on the quality of life and weighs heavily on public health expenditures. In brain tumor patients, the presence of epilepsy is considered as the most important risk factor for long-term disability. For this reason, the problem of the proper administration of medications and their potential side effects is of great importance, because good seizure control can significantly improve the patient's psychological and relational sphere. In these patients, new generation drugs such as gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, topiramate, and zonisamide are preferred, because they have fewer drug interactions and cause fewer side effects. Among the recently marketed drugs, lacosamide has demonstrated promising results and should be considered as a possible treatment option. Therefore, it is necessary to develop a customized treatment plan for each patient with BTRE, whose goals are complete seizure control, minimal or no side effects, and elimination of cognitive impairment and/or psychosocial problems.
在脑肿瘤患者中，20-40%的患者以癫痫发作为首发症状，而另有 20-45%的患者在病程中出现癫痫。这些数据对于考虑为这一特定患者群体选择抗癫痫药物非常重要，因为脑肿瘤相关性癫痫（BTRE）往往具有耐药性，对生活质量有很大影响，并给公共卫生支出带来沉重负担。在脑肿瘤患者中，癫痫的存在被认为是导致长期残疾的最重要的危险因素。出于这个原因，药物的合理管理及其潜在副作用的问题非常重要，因为良好的癫痫控制可以显著改善患者的心理和社交领域。在这些患者中，首选加巴喷丁、拉莫三嗪、左乙拉西坦、奥卡西平、普瑞巴林、托吡酯和唑尼沙胺等新一代药物，因为它们相互作用较少，副作用较少。在最近上市的药物中，拉科酰胺显示出了有前景的结果，应被视为一种可能的治疗选择。因此，有必要为每位 BTRE 患者制定个性化的治疗计划，其目标是完全控制癫痫发作，最小化或无副作用，并消除认知障碍和/或心理社会问题。
