Abstract
Purpose: To elucidate the outcomes of treatment and epidemiology of epilepsy related to glioma in a single center in Chinese patients.Methods: Prescription medicines usage and clinical data were collected from medical records of 119 patients with gliomas between August 2009 and September 2015. Fisher’s exact and Chi square tests were used for analysis of seizure incidence differences as per WHO Grades, histology, location as well as tumour number, age and sex.Results: Preoperative seizures were noted in 33.8 % of glioma patients. After surgery, all the patients were given antiepileptic drugs (AEDs) prophylactically. Ten patients (8.4 %) developed seizures in the initial postoperative week, and 73 (61.3 %) patients at the last follow-up period. Overall, seizure incidence was 74.2 % in WHO Grade II, 68.4 % in Grade III, and 56.6 % in Grade IV glioma patients. Good seizure control and tolerance was demonstrated by levetiracetam. Phenytoin/carbamazepine were poorly tolerated due to adverse events. AED discontinuation was done in 54 patients and 14 patients developed seizures within 6 months and again needed AED.Conclusion: Effective prophylaxis of seizure and acceptable adverse event profile are to be considered significantly in AEDs selection. Lower cognitive impairment risk and renal excretion associated with newer AEDs make them better than older therapeutic agents for epilepsy control in brain tumour patients.Keywords: Brain tumour, Epilepsy, Glioma, Seizures, Levetiracetam, Phenytoin, Carbamazepine,Epidemiology
Highlights
Epilepsy is typical in brain tumour patients, and its control plays imperative part in clinical management
Hurdles of epilepsy medical treatment in brain tumour patients encompass the epilepsy refractoriness, which may be due to potential interactions of antiepileptic drugs (AEDs) as well as chemotherapeutic agents; multidrug-resistance proteins; and potential cognitive side-effects on utilization of AED besides prior damage to brain from radiotherapy or surgery [2,3]
The seizure incidence was significantly higher in patients having Grade II tumours than patients having Grade IV tumours (p = 0.026)
Summary
Epilepsy is typical in brain tumour patients, and its control plays imperative part in clinical management. Convulsions add up considerable morbidity in brain tumour patients [1]. Epilepsy in brain tumour patients are mostly symptomatic and localization associated, showing as either simple or complex seizures with/without secondary generalization. A variety of factors influence epileptogenesis in brain tumour patients, namely tumour location and type, peritumoural environmental changes, and genetic factors. Hurdles of epilepsy medical treatment in brain tumour patients encompass the epilepsy refractoriness, which may be due to potential interactions of antiepileptic drugs (AEDs) as well as chemotherapeutic agents; multidrug-resistance proteins; and potential cognitive side-effects on utilization of AED besides prior damage to brain from radiotherapy or surgery [2,3]. The brain tumour incidence in epilepsy patients is around 4 %. The seizure frequency is around 30 % or more in brain tumour patients, relying upon tumour type. Epilepsy is the major medical sign of tumour in nearly 30 – 50 % of brain tumour patients; 10 – 30 % of patients develop epilepsy during the tumour course [2,3,4,5,6]
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