Iuchi Toshihiko, Hasegawa Yuzo, Kawasaki Koichiro, Sakaida Tsukasa
Division of Neurological Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Japan.
Division of Neurological Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, Japan.
J Clin Neurosci. 2015 Jan;22(1):87-91. doi: 10.1016/j.jocn.2014.05.036. Epub 2014 Sep 2.
Brain tumor-related epilepsy (BTRE) is a unique condition that is distinct from primary epilepsy. The aim of this retrospective study was to clarify the epidemiology and results of treatment of BTRE in a single institution. From a database of 121 consecutive patients with supratentorial gliomas treated at Chiba Cancer Center from 2006-2012, the incidence and control of seizures before and after surgery were retrospectively evaluated. Epilepsy occurred in 33.9% of patients before surgery. All patients received prophylactic anti-epileptic drugs (AED) during surgery; however, seizures occurred in 9.1% of patients within the first postoperative week. During follow-up, seizures occurred in 48.3% of patients. The overall incidence of seizures was 73.7% in patients with World Health Organization Grade II gliomas, 66.7% in those with Grade III and 56.8% in those with Grade IV gliomas. Levetiracetam was very well tolerated. However, carbamazepine and phenytoin were poorly tolerated because of adverse effects. AED were discontinued in 56 patients. Fifteen of these patients (26.8%) had further seizures, half occurring within 3 months and 80% within 6 months of AED withdrawal. No clinical factors that indicated it was safe to discontinue AED were identified. The unpredictable epileptogenesis associated with gliomas and their excision requires prolonged administration of AED. To maintain quality of life and to safely and effectively control the tumor, it is necessary to select AED that do not adversely affect cognitive function or interact with other drugs, including anti-cancer agents.
脑肿瘤相关性癫痫（BTRE）是一种有别于原发性癫痫的独特病症。本回顾性研究的目的是阐明单机构中BTRE的流行病学及治疗结果。从2006年至2012年在千叶癌症中心接受治疗的121例连续性幕上胶质瘤患者的数据库中，对手术前后癫痫发作的发生率及控制情况进行回顾性评估。术前33.9%的患者发生癫痫。所有患者在手术期间均接受预防性抗癫痫药物（AED）治疗；然而，术后第一周内9.1%的患者发生癫痫发作。在随访期间，48.3%的患者发生癫痫发作。世界卫生组织二级胶质瘤患者癫痫发作的总体发生率为73.7%，三级患者为66.7%，四级患者为56.8%。左乙拉西坦耐受性良好。然而，卡马西平和苯妥英钠因不良反应耐受性较差。56例患者停用AED。其中15例患者（26.8%）再次发作，一半在停用AED后3个月内发作，80%在6个月内发作。未发现表明停用AED安全的临床因素。与胶质瘤及其切除相关的不可预测的癫痫发生需要长期服用AED。为维持生活质量并安全有效地控制肿瘤，有必要选择对认知功能无不利影响且不与包括抗癌药物在内的其他药物相互作用的AED。
