Neurosurgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria,
Neurosurg Rev. 2014 Jul;37(3):381-8; discussion 388. doi: 10.1007/s10143-014-0538-6. Epub 2014 Apr 24.
Epileptic seizures represent a common signal of intracranial tumors, frequently the presenting symptom and the main factor influencing quality of life. Treatment of tumors concentrates on survival; antiepileptic drug (AED) treatment frequently is prescribed in a stereotyped way. A differentiated approach according to epileptic syndromes can improve seizure control and minimize unwarranted AED effects. Prophylactic use of AEDs is to be discouraged in patients without seizures. Acutely provoked seizures do not need long-term medication except for patients with high recurrence risk indicated by distinct EEG patterns, auras, and several other parameters. With chronically repeated seizures (epilepsies), long-term AED treatment is indicated. Non-enzyme-inducing AEDs might be preferred. Valproic acid exerts effects against progression of gliomatous tumors. In low-grade astrocytomas with epilepsy, a comprehensive presurgical epilepsy work-up including EEG-video monitoring is advisable; in static non-progressive tumors, it is mandatory. In these cases, the neurosurgical approach has to include the removal of the seizure-onset zone frequently located outside the lesion.
癫痫发作是颅内肿瘤的常见信号，常为首发症状，也是影响生活质量的主要因素。肿瘤的治疗侧重于生存；抗癫痫药物（AED）的治疗常常是刻板的。根据癫痫综合征的不同，采用差异化的治疗方法可以改善癫痫发作的控制，最大限度地减少不必要的 AED 影响。对于无癫痫发作的患者，不鼓励预防性使用 AED。急性诱发性癫痫发作不需要长期药物治疗，除非患者存在明显的脑电图模式、先兆和其他几个参数提示高复发风险。对于慢性反复发作的癫痫（癫痫），需要长期使用 AED 治疗。非酶诱导的 AED 可能更有优势。丙戊酸对胶质瘤肿瘤的进展有抑制作用。对于伴癫痫的低级别星形细胞瘤，建议进行全面的术前癫痫评估，包括脑电图-视频监测；对于静止性非进行性肿瘤，这是强制性的。在这些情况下，神经外科的方法必须包括切除常位于病变外的起始癫痫发作区。
