Abstract
In patients with brain tumor (BT), seizures are the onset symptom in 20-40% of patients, while a further 20-45% of patients will present them during the course of the disease. These patients present a complex therapeutic profile and require a unique and multidisciplinary approach. The choice of antiepileptic drugs is challenging for this particular patient population because brain tumor-related epilepsy (BTRE) is often drug-resistant, has a strong impact on the quality of life and weighs heavily on public health expenditures.In BT patients, the presence of epilepsy is considered the most important risk factor for long-term disability. For this reason, the problem of the proper administration of medications and their potential side effects is of great importance, because good seizure control can significantly improve the patient’s psychological and relational sphere. In these patients, new generation drugs such as gabapentin, lacosamide, levetiracetam, oxcarbazepine, pregabalin, topiramate, zonisamide are preferred because they have fewer drug interactions and cause fewer side effects. Among the recently marketed drugs, lacosamide has demonstrated promising results and should be considered a possible treatment option. Therefore, it is necessary to develop a customized treatment plan for each individual patient with BTRE. This requires a vision of patient management concerned not only with medical therapies (pharmacological, surgical, radiological, etc.) but also with emotional and psychological support for the individual as well as his or her family throughout all stages of the illness.
Highlights
Patients with brain tumor related epilepsy (BTRE) present a complex therapeutic profile and require a unique and multidisciplinary approach
There is the management of pharmacological therapies: the concurrent use of antiepileptic drugs (AEDs), chemotherapy (CT), and support therapies can present problems with drug interactions and collateral effects [1]
Studies have been published that have evaluated the percentage of side effects that appeared in BTRE patients
Summary
Patients with brain tumor related epilepsy (BTRE) present a complex therapeutic profile and require a unique and multidisciplinary approach. In 73% of patients with BTs, epilepsy can be the presenting symptom or can occur during the course of the oncological disease due to a number of factors: 1) directly relating to the reoccurance of brain cancer or to disease progression; 2) directly related to the therapies (CT, support therapies and radionecrosis) or for other causes such as vascular, intective, metobolic, and limbic encephalopathy [18]. Marginalization and rejection are especially felt by individuals who have a visible physical disability like hemiparesis or problems with speech (which may be due to the site of the tumor), and by those whose physical aspect has been altered due to systemic therapies (hair loss from radiation, ritention of liquids, or noticeable weight gain due to the assumption of steroids) All of these factors together with the label “epileptic” can cause the patient to feel extremely frustrated when attempting any type of social and/or interpersonal relationship. Many studies (metaanalyses) pertaining to epileptic patients have been done, but it is difficult to transfer the results to clinical practice [15,47,48,49,50]
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