Ertürk Çetin Özdem, İşler Cihan, Uzan Mustafa, Özkara Çiğdem
Istanbul University, Cerrahpasa Faculty of Medicine, Department of Neurology, 34098, Fatih, Istanbul, Turkey.
Istanbul University, Cerrahpasa Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey.
Seizure. 2017 Jan;44:93-97. doi: 10.1016/j.seizure.2016.12.012. Epub 2016 Dec 21.
Seizures are among the most common presentations of brain tumors. Several tumor types can cause seizures in varying rates; neuroglial tumors and the gliomas are the most common ones. Brain tumors are the second most common cause of focal intractable epilepsy in epilepsy surgery series, with the highest frequency being dysembryoplastic neuroepithelial tumors and gangliogliomas. Seizure management is an important part of the treatment of patients with brain tumors. This review discusses clinical features and management of seizures in patients with brain tumors, including, neuroglial tumors, gliomas, meningioma and metastases; with the help of recent literature data. Tumor-related seizures are focal seizures with or without secondary generalization. Seizures may occur either as initial symptom or during the course of the disease. Brain tumors related epilepsy tends to be resistant to antiepileptic drugs and treatment of tumor is main step also for the seizure treatment. Early surgery and extent of the tumor removal are important factors for achieving seizure freedom particularly in neuroglial tumors and low grade gliomas. During selection of the appropriate antiepileptic drug, the general approach to partial epilepsies can be followed. There are several factors influencing epileptogenesis in brain tumor-related epilepsy which also explains clinical heterogeneity of epilepsy among tumor types. Identification of molecular markers may guide future therapeutic approaches and further studies are needed to prove antitumor effects of different antiepileptic drugs.
癫痫发作是脑肿瘤最常见的症状之一。几种肿瘤类型可导致不同发生率的癫痫发作；神经胶质肿瘤和胶质瘤是最常见的。在癫痫手术系列中，脑肿瘤是局灶性难治性癫痫的第二大常见病因，其中胚胎发育不良性神经上皮肿瘤和神经节胶质瘤的发生率最高。癫痫管理是脑肿瘤患者治疗的重要组成部分。本综述借助近期文献数据，讨论了脑肿瘤患者癫痫发作的临床特征和管理，包括神经胶质肿瘤、胶质瘤、脑膜瘤和转移瘤。肿瘤相关性癫痫发作是伴有或不伴有继发性全身性发作的局灶性发作。癫痫发作可能作为初始症状出现，也可能在疾病过程中发生。脑肿瘤相关性癫痫往往对抗癫痫药物耐药，肿瘤治疗也是癫痫治疗的主要步骤。早期手术和肿瘤切除范围是实现无癫痫发作的重要因素，尤其是在神经胶质肿瘤和低级别胶质瘤中。在选择合适的抗癫痫药物时，可以遵循部分性癫痫的一般治疗方法。有几个因素影响脑肿瘤相关性癫痫的癫痫发生，这也解释了不同肿瘤类型癫痫的临床异质性。分子标志物的鉴定可能会指导未来的治疗方法，需要进一步研究以证实不同抗癫痫药物的抗肿瘤作用。
