Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Acta Neurochir (Wien). 2013 Oct;155(10):1833-7. doi: 10.1007/s00701-013-1826-6. Epub 2013 Aug 28.
The prevalence, risk factors, and clinical implication of seizure development were investigated in patients with metastatic brain tumors.
Medical records and radiological findings were analyzed retrospectively in 258 patients with brain metastasis from lung cancer who underwent Gamma Knife radiosurgery (GKS) between January 2008 and December 2009.
During the follow-up period 32 patients (12.4 %) experienced seizure episodes. Coexistence of leptomeningeal seeding was a significant risk factor related to development of seizure (p < 0.001). Prophylactic use of anticonvulsants was not correlated with reduction of seizure incidence (p = 0.818). Continued use of anticonvulsants was necessary in nine of the 258 patients (3.5 %) because of recurrent seizures. Imaging studies performed immediately after seizure attacks in the patients with known metastatic brain lesions revealed tumor progression or complications related to treatment in 35 of 42 episodes of seizure (77.8 %).
Patients with metastatic lesions have a substantial risk of developing seizure. Seizure in known metastatic brain tumor patients are usually related to disease progression or complications of treatment. Follow-up imaging should be considered for each seizure episode and adequate multimodal treatment needs to be added to antiepileptic medication.
研究了转移性脑肿瘤患者癫痫发作的患病率、危险因素和临床意义。
回顾性分析了 2008 年 1 月至 2009 年 12 月期间 258 例肺癌脑转移患者接受伽玛刀放射外科治疗（GKS）的病历和影像学检查结果。
在随访期间，32 例患者（12.4%）出现癫痫发作。软脑膜播散的共存是与癫痫发作发展相关的显著危险因素（p<0.001）。预防性使用抗癫痫药与降低癫痫发作发生率无关（p=0.818）。258 例患者中有 9 例（3.5%）因癫痫反复发作而需要继续使用抗癫痫药。在已知有转移性脑病变的患者中，在癫痫发作后立即进行的影像学检查显示 42 次癫痫发作中的 35 次（77.8%）与肿瘤进展或与治疗相关的并发症有关。
转移性病变患者发生癫痫的风险很大。已知患有脑转移瘤的患者的癫痫发作通常与疾病进展或治疗相关的并发症有关。应考虑对每次癫痫发作进行随访，并在抗癫痫药物治疗的基础上增加适当的多模式治疗。
