Chassoux F, Landre E
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France; Paris-Descartes University, 75005 Paris, France.
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France; Paris-Descartes University, 75005 Paris, France.
Neurochirurgie. 2017 Jun;63(3):197-203. doi: 10.1016/j.neuchi.2016.10.013. Epub 2017 Jun 7.
Epilepsy related to brain tumors is often difficult to treat and may impact the quality of life. We performed a review of current recommendations for the prevention of postoperative seizures and optimizing the anti-epileptic treatment.
Based on studies performed since 2000 we conducted the review by (1) analyzing the incidence of tumoral epilepsy and mechanisms of epileptogenicity; (2) describing the current medical and surgical strategy according to oncologic treatments; (3) discussing the management of postoperative seizures; (4) considering the drug withdrawal after oncologic therapy.
Epilepsy related to supra-tentorial brain tumors is frequent (40-60%) especially in low-grade gliomas, glioneuronal tumors, fronto-temporal and eloquent cortex locations. Seizures can occur as a presenting symptom or during the course of the tumor, including after surgery and oncological treatments. Maximal safe surgical resection is the more effective therapy, alone or combined with adjuvant therapy (chemotherapy, radiotherapy). Anti-epileptic drugs are not indicated for epilepsy prophylaxis in patients without seizures but only after the first seizure due to high risk of recurrence. As they may generate adverse effects and interfere with oncological treatments, the choice is based on efficacy, tolerability and potential interactions. New anti-epileptic non-enzyme-inducing drugs are recommended in first-line monotherapy in association with adjuvant oncological therapies. Enzyme-inhibiting drugs could have a favorable effect on survival. Late seizures are often related to tumor progression or recurrence. Discontinuation of anti-epileptic drugs could be considered after successful oncological treatment and a stable medical condition.
These guidelines are helpful for a rational therapy in tumoral epilepsy.
与脑肿瘤相关的癫痫通常难以治疗，可能会影响生活质量。我们对当前预防术后癫痫发作和优化抗癫痫治疗的建议进行了综述。
基于2000年以来开展的研究，我们通过以下方式进行综述：（1）分析肿瘤性癫痫的发病率和致痫机制；（2）根据肿瘤治疗方法描述当前的药物和手术策略；（3）讨论术后癫痫发作的管理；（4）考虑肿瘤治疗后的药物撤停。
幕上脑肿瘤相关的癫痫很常见（40%-60%），尤其是在低级别胶质瘤、神经胶质神经元肿瘤、额颞叶和功能区皮质部位。癫痫发作可作为首发症状出现，也可在肿瘤病程中发生，包括手术后和肿瘤治疗期间。最大安全手术切除是更有效的治疗方法，可单独使用或与辅助治疗（化疗、放疗）联合使用。对于无癫痫发作的患者，不建议使用抗癫痫药物预防癫痫，仅在首次发作后使用，因为复发风险高。由于它们可能产生不良反应并干扰肿瘤治疗，选择基于疗效、耐受性和潜在相互作用。推荐新型非酶诱导抗癫痫药物作为一线单药治疗并联合辅助肿瘤治疗。酶抑制药物可能对生存有有利影响。晚期癫痫发作通常与肿瘤进展或复发有关。在肿瘤治疗成功且病情稳定后可考虑停用抗癫痫药物。
这些指南有助于对肿瘤性癫痫进行合理治疗。
