Fröscher W, Kirschstein T, Rösche J
Zentrum für Psychiatrie Südwürttemberg, Epilepsie-Zentrum Bodensee, Ravensburg-Weißenau.
Oscar-Langendorff-Institut für Physiologie, Universitätsmedizin Rostock.
Fortschr Neurol Psychiatr. 2014 Dec;82(12):678-90. doi: 10.1055/s-0034-1385475. Epub 2014 Dec 9.
The lifetime risk of patients with brain tumours to have focal epileptic seizures is 20-80%. Based on current evidence the management of tumour-related seizures does not differ substantially from that applied to epilepsies from other aetiologies. Therefore, the choice of an anticonvulsant is based, above all, on tolerability and pharmacokinetic interactions with chemotherapeutic drugs. Levetiracetam is recommended by many authors as first-line therapy in brain tumour-related epilepsy; this corresponds with the recommendation of the German guidelines on the treatment of focal seizures of any aetiology. Based on current evidence, the prophylactic prescription of long-term antiepileptic drugs in brain tumour patients who have not presented with seizures is not justified. Because of the high risk of recurrence, however, antiepileptic treatment should be strongly considered after a single brain tumour-related seizure.
脑肿瘤患者发生局灶性癫痫发作的终生风险为20%-80%。基于目前的证据，肿瘤相关性癫痫的治疗与其他病因所致癫痫的治疗并无实质性差异。因此，抗惊厥药物的选择首先基于耐受性以及与化疗药物的药代动力学相互作用。许多作者推荐左乙拉西坦作为脑肿瘤相关性癫痫的一线治疗药物；这与德国关于任何病因所致局灶性癫痫发作治疗的指南推荐一致。基于目前的证据，对于尚未出现癫痫发作的脑肿瘤患者预防性长期使用抗癫痫药物并无依据。然而，由于复发风险高，在单次脑肿瘤相关性癫痫发作后应强烈考虑抗癫痫治疗。
