Englot Dario J, Chang Edward F, Vecht Charles J
UCSF Comprehensive Epilepsy Center, University of California San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Service Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Handb Clin Neurol. 2016;134:267-85. doi: 10.1016/B978-0-12-802997-8.00016-5.
Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70-80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60-75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20-50% of patients with meningioma and 20-35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60-90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.
癫痫发作在脑肿瘤患者中很常见，癫痫会显著影响患者的生活质量。因此，全面了解癫痫发作的发生率和预测因素，以及切除术后无癫痫发作的可能性，对于脑肿瘤的治疗至关重要。在所有肿瘤类型中，癫痫发作在神经胶质神经元肿瘤患者中最为常见（70 - 80%），尤其是额颞叶或岛叶病变的患者。癫痫发作在胶质瘤患者中也很常见，位于浅表皮质或岛叶区域的低级别胶质瘤患者癫痫发生率最高（60 - 75%）。约20 - 50%的脑膜瘤患者和20 - 35%的脑转移瘤患者也会发生癫痫发作。肿瘤切除术后，约60 - 90%的患者可实现无癫痫发作，神经胶质神经元肿瘤患者的癫痫发作结果最为理想。肿瘤全切、早期手术治疗以及无全身性癫痫发作是癫痫发作结果良好的常见预测因素。关于抗惊厥药物的选择，应遵循基于证据的局灶性癫痫治疗指南，同时也应考虑个体患者因素，包括患者年龄、性别、器官功能障碍、合并症或联合治疗。由于辅助化疗通常是胶质瘤治疗的重要组成部分，应尽可能避免使用酶诱导性抗惊厥药物。鉴于癫痫发作对生活质量的不利影响，无癫痫发作是癫痫性脑肿瘤患者治疗的最终目标。
