Seizures In Brain Tumor Patients Research Articles

Risk Factors for Pre- and Postoperative Seizures in Brain Tumor Patients

Use of antiseizure medication in brain tumor patients remains inconsistent and based mostly on physician preference rather than on evidence or guidelines ( Neurology 2000; 54:1886). To identify potential risk factors for seizures preoperatively and in the week after operation for brain tumors, researchers retrospectively studied 650 brain tumor patients evaluated and treated at one center. The study was designed to support future prospective studies that might exploit risk stratification. The authors analyzed the following key risk …

The Role of Levetiracetam in Treatment of Seizures in Brain Tumor Patients

Levetiracetam, trade name Keppra, is a new second generation antiepileptic drug that is being increasingly used in brain tumor patients. In patients suffering with brain tumors, seizures are one of the leading neurologic complications being seen in more than 30% of patients. Unlike other antiepileptic drugs, levetiracetam is proposed to bind to a synaptic vesicle protein inhibiting calcium release. Brain tumor patients are frequently on chemotherapy or other drugs that induce cytochrome P450, causing significant drug interactions. However, levetiracetam does not induce the P450 system and does not exhibit any relevant drug interactions. Intravenous delivery is as bioavailable as the oral medication allowing it to be used in emergency situations. Levetiracetam is an attractive option for brain tumor patients suffering from seizures, but also can be used prophylactically in patients with brain tumors, or patients undergoing neurological surgery. Emerging studies have also demonstrated that levetiracetam can increase the sensitivity of Glioblastoma tumors to the chemotherapy drug temozolomide. Levetiracetam is a safe alternative to conventional antiepileptic drugs and an emerging tool for brain tumor patients combating seizures.

Epilepsy is related to theta band brain connectivity and network topology in brain tumor patients

BackgroundBoth epilepsy patients and brain tumor patients show altered functional connectivity and less optimal brain network topology when compared to healthy controls, particularly in the theta band. Furthermore, the duration and characteristics of epilepsy may also influence functional interactions in brain networks. However, the specific features of connectivity and networks in tumor-related epilepsy have not been investigated yet. We hypothesize that epilepsy characteristics are related to (theta band) connectivity and network architecture in operated glioma patients suffering from epileptic seizures. Included patients participated in a clinical study investigating the effect of levetiracetam monotherapy on seizure frequency in glioma patients, and were assessed at two time points: directly after neurosurgery (t1), and six months later (t2). At these time points, magnetoencephalography (MEG) was recorded and information regarding clinical status and epilepsy history was collected. Functional connectivity was calculated in six frequency bands, as were a number of network measures such as normalized clustering coefficient and path length.ResultsAt the two time points, MEG registrations were performed in respectively 17 and 12 patients. No changes in connectivity or network topology occurred over time. Increased theta band connectivity at t1 and t2 was related to a higher total number of seizures. Furthermore, higher number of seizures was related to a less optimal, more random brain network topology. Other factors were not significantly related to functional connectivity or network topology.ConclusionsThese results indicate that (pathologically) increased theta band connectivity is related to a higher number of epileptic seizures in brain tumor patients, suggesting that theta band connectivity changes are a hallmark of tumor-related epilepsy. Furthermore, a more random brain network topology is related to greater vulnerability to seizures. Thus, functional connectivity and brain network architecture may prove to be important parameters of tumor-related epilepsy.

A prospective evaluation and literature review of levetiracetam use in patients with brain tumors and seizures

To determine the safety and tolerability of IV and oral levetiracetam monotherapy for seizures in brain tumor patients following resection. Brain tumor patients undergoing neurosurgery with >or=1 seizure within the preceding month prior to surgery were enrolled to receive intravenous levetiracetam for a minimum of 48 h, transitioned to oral levetiracetam at the same dose, and followed for 1-month after discharge. Patients were assessed daily in the hospital, provided with a seizure diary, and supplied with 30 days of levetiracetam upon discharge. Study patients were telephoned weekly to assess their cognitive status and seizure frequency. Of the 17 patients enrolled, the baseline seizure types were tonic clonic, partial, and complex partial with secondary generalization. The most common type of tumor was glioblastoma multiforme. Levetiracetam was well tolerated with no medication discontinuation during the study period. Adverse effects reported were somnolence, nausea/vomiting, headache, and insomnia. Eleven patients were evaluable for TICS scores (64.7%) with an average score of 33.3. Two patients were deemed to be cognitively impaired (18.2%). Eleven of twelve patients (91.7%) that completed the study period achieved a >or=50% reduction in their number of seizures. A total of 92 drug interactions were avoided (P = 0.0016) with dexamethasone, acetaminophen, and fentanyl being the most common. Levetiracetam monotherapy was found to be safe and tolerable in this patient population. Nearly all patients achieved a >or=50% reduction in seizure frequency post-op with levetiracetam monotherapy. Levetiracetam also has the potential for less drug interactions compared to phenytoin in these patients.

The Management of Seizures in Brain Tumor Patients

The diagnosis of a brain tumor requires healthcare providers to examine the best course of treatment for each individual patient. Unfortunately, seizures are a common occurrence in those with brain tumors. Seizures can contribute to many undesirable life-altering consequences that can greatly impact quality of life. Healthcare providers are inconsistent in the use of prophylactic antiepileptic drugs. Despite published guidelines, prophylactic use of antiepileptic drugs is still practiced for patients who have never experienced a seizure. Because of the many side effects of first-generation antiepileptic drugs, this practice should be discouraged. Furthermore, drug interactions between antiepileptic drugs and antineoplastic treatments can cause life-threatening complications. Since the 1990s, newer antiepileptic drugs, which have fewer drug interactions, have been introduced and show promise as first-line therapy and adjunct treatment of epilepsy. Although reports have demonstrated their promise, prospective randomized controlled trials are needed to determine their reliability in this population of patients. Managing seizures in brain tumor patients requires diligent comprehensive care by healthcare providers to help limit unnecessary side effects and improve quality of life.

The Management of Seizures in Brain Tumor Patients

Journal of Neuroscience Nursing: February 2010 - Volume 42 - Issue 1 - p 38-39 doi: 10.1097/JNN.0b013e3181cdb3fb

Seizures and Epilepsy in Cancer Patients

Seizures in the general population may occur for a variety of reasons, including vascular, infectious, autoimmune, genetic, and traumatic causes. In the cancer population, seizures arise mainly as a result of an infiltrative neoplastic process in the brain. However, seizures as a result of cancer treatment, metabolic causes, or paraneoplastic diseases may occur in patients with systemic cancer, even in the absence of a cerebral lesion. The etiology of seizures in brain tumor patients includes primary cerebral neoplasms and metastatic brain lesions. The treatment for seizures in this population is multifaceted and involves surgery, radiation, chemotherapy, and antiepileptic drugs. All treatments have potential adverse effects, especially when combined. The treatment for brain tumor-associated seizures and epilepsy almost always is geared toward treating the tumor, but subsequent treatment of seizures often is necessary. A pragmatic approach to this problem is essential to mitigate potential complications from treatment.

Efficacy of anti-epileptic drugs in patients with gliomas and seizures

Although seizures in brain tumor patients are common, the knowledge on optimal anti-seizure therapy in this patient group is limited. An observational study was carried out using a database of all patients from the neuro-oncology service during the period 2000-2005, with data on seizure characteristics, therapy with AEDs, the underlying brain tumor and its treatment. A total of 140 brain tumor patients were studied of whom 23.6% had a low-grade glioma, 53.6% a high-grade glioma, and 22.8% belonged to a mixed group existing of ependymoma, meningioma, and brain metastasis. Epilepsy as the presenting sign was more frequent in low-grade vs. high-grade gliomas (69.7 vs. 52%, P = 0.087), and a total of 75.8% of patients developed seizures with low-grade and of 80.0% with high-grade gliomas. Of all 99 patients with seizures, 80.1% received valproic acid (VPA) as first choice, and either levetiracetam (LEV), carbamazepine (CBZ) or lamotrigine (LMT) as the most frequent next choice. Patients treated with a combination of VPA and LEV showed the highest percentage of responders (81.5%), with a decline in seizure frequency of more than two categories in 55.6% and seizure freedom in 59%. No correlation was found between the use of VPA and survival. A combination of VPA and LEV seems effective, if seizure control cannot be achieved by VPA alone. This indicates that adding levetiracetam may be preferable over sequential trials of AED monotherapy in treatment-resistant seizures in patients with brain tumors.

Management of Seizures in Brain Tumor Patients at the End of Life

Few data exist on the management of seizures in brain tumor patients near the end of life. This article provides information on the epidemiology and phenomenology of seizures, as well as on differential diagnostic considerations. Based largely on empirical data from the pediatric epilepsy literature, guidelines for management of seizures near the end of life are given, with emphasis on the use of rectal antiepileptic drugs.