Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Department of Neurology, Harvard Medical School, Boston, MA, USA.
Curr Neurol Neurosci Rep. 2024 Sep;24(9):413-422. doi: 10.1007/s11910-024-01360-z. Epub 2024 Jul 17.
Brain tumor-related epilepsy is a heterogenous syndrome involving variability in incidence, timing, pathophysiology, and clinical risk factors for seizures across different brain tumor pathologies. Seizure risk and disability are dynamic over the course of disease and influenced by tumor-directed treatments, necessitating individualized patient-centered management strategies to optimize quality of life.
Recent translational findings in diffuse gliomas indicate a dynamic bidirectional relationship between glioma growth and hyperexcitability. Certain non-invasive measures of hyperexcitability are correlated with survival outcomes, however it remains uncertain how to define and measure clinically relevant hyperexcitability serially over time. The extent of resection, timing of pre-operative and/or post-operative seizures, and the likelihood of tumor progression are critical factors impacting the risk of seizure recurrence. Newer anti-seizure medications are generally well-tolerated with similar efficacy in this population, and several rapid-onset seizure rescue agents are in development and available. Seizures in patients with brain tumors are strongly influenced by the underlying tumor biology and treatment. An improved understanding of the interactions between tumor cells and the spectrum of hyperexcitability will facilitate targeted therapies. Multidisciplinary management of seizures should occur with consideration of tumor-directed therapy and prognosis, and anti-seizure medication decision-making tailored to the individual priorities and quality of life of the patient.
脑肿瘤相关性癫痫是一种异质性综合征，不同脑肿瘤病理类型的癫痫发生率、发生时间、病理生理学和临床发作风险因素存在差异。癫痫发作风险和残疾在疾病过程中是动态变化的，受肿瘤靶向治疗的影响，因此需要制定个体化的以患者为中心的管理策略，以优化生活质量。
弥漫性胶质瘤的最新转化研究结果表明，胶质瘤生长与过度兴奋之间存在动态双向关系。某些过度兴奋的非侵入性测量指标与生存结局相关，但尚不确定如何在时间上定义和测量临床上相关的过度兴奋。切除程度、术前和/或术后癫痫发作的时间以及肿瘤进展的可能性是影响癫痫复发风险的关键因素。新型抗癫痫药物在该人群中通常具有良好的耐受性和相似的疗效，并且正在开发和提供几种快速发作的癫痫急救药物。脑肿瘤患者的癫痫发作强烈受潜在肿瘤生物学和治疗的影响。深入了解肿瘤细胞与过度兴奋谱之间的相互作用将有助于靶向治疗。应考虑肿瘤靶向治疗和预后进行癫痫发作的多学科管理，并且应根据患者的个人优先事项和生活质量来制定抗癫痫药物决策。
