Brain Tumor-Related Epilepsy: a Current Review of the Etiologic Basis and Diagnostic and Treatment Approaches.

Abstract

The relationship of brain tumors and seizures remains poorly understood. This article is an overview of the epidemiology, etiology, and diagnostic and treatment approaches of tumor-related epilepsy primarily with regard to glial-based tumors, the most commonly considered brain tumor in this field. Over the past many years, several novel etiologic mechanisms to explain how tumors induce seizures have been developed, which this article reviews, including the roles of glutamate-induced excitotoxicity, matrix metalloproteinases, isocitrate dehydrogenase, methylguanine methyltransferase, and functional network connectivity. As well, diagnostic and treatment approaches vary considerably. This article summarizes the evidence and provides the rationale for a reconsideration of how we deliver pre-operative, peri-operative, and post-operative care to these patients. Patients with brain tumors and epilepsy are a very challenging subgroup of patients, which necessitates not just a thorough understanding of the current principles regarding tumor-related epilepsy but also the development of collaborative research to advance our knowledge even further, and a concerted effort to develop a standardized, multi-disciplinary clinical approach to improve the care of these patients.