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Management of epilepsy in brain tumor patients

A concise review of recent findings in brain tumor-related epilepsy (BTRE), with focus on the effect of antitumor treatment on seizure control and the management of antiepileptic drugs (AEDs). RECENT FINDINGS: Isocitrate dehydrogenase mutation and its active metabolite d-2-hydroxyglutarate seem impo...

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Autores principales: van der Meer, Pim B., Taphoorn, Martin J.B., Koekkoek, Johan A.F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9594141/
https://www.ncbi.nlm.nih.gov/pubmed/35838207
http://dx.doi.org/10.1097/CCO.0000000000000876
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author van der Meer, Pim B.
Taphoorn, Martin J.B.
Koekkoek, Johan A.F.
author_facet van der Meer, Pim B.
Taphoorn, Martin J.B.
Koekkoek, Johan A.F.
author_sort van der Meer, Pim B.
collection PubMed
description A concise review of recent findings in brain tumor-related epilepsy (BTRE), with focus on the effect of antitumor treatment on seizure control and the management of antiepileptic drugs (AEDs). RECENT FINDINGS: Isocitrate dehydrogenase mutation and its active metabolite d-2-hydroxyglutarate seem important contributing factors to epileptogenesis in BTRE. A beneficial effect of antitumor treatment (i.e. surgery, radiotherapy, and chemotherapy) on seizure control has mainly been demonstrated in low-grade glioma. AED prophylaxis in seizure-naïve BTRE patients is not recommended, but AED treatment should be initiated after a first seizure has occurred. Comparative efficacy randomized controlled trials (RCTs) are currently lacking, but second-generation AED levetiracetam seems the preferred choice in BTRE. Levetiracetam lacks significant drug-drug interactions, has shown favorable efficacy compared to valproic acid in BTRE, generally causes no hematological or neurocognitive functioning adverse effects, but caution should be exercised with regard to psychiatric adverse effects. Potential add-on AEDs in case of uncontrolled seizures include lacosamide, perampanel, and valproic acid. Ultimately, in the end-of-life phase when oral intake of medication is hampered, benzodiazepines via nonoral administration routes are potential alternatives. SUMMARY: Management of seizures in BTRE is complex and with currently available evidence levetiracetam seems the preferred choice. Comparative efficacy RCTs in BTRE are warranted.
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spelling pubmed-95941412022-10-27 Management of epilepsy in brain tumor patients van der Meer, Pim B. Taphoorn, Martin J.B. Koekkoek, Johan A.F. Curr Opin Oncol BRAIN AND NERVOUS SYSTEM: Edited by Marc Sanson and Anna-Luisa Di Stefano A concise review of recent findings in brain tumor-related epilepsy (BTRE), with focus on the effect of antitumor treatment on seizure control and the management of antiepileptic drugs (AEDs). RECENT FINDINGS: Isocitrate dehydrogenase mutation and its active metabolite d-2-hydroxyglutarate seem important contributing factors to epileptogenesis in BTRE. A beneficial effect of antitumor treatment (i.e. surgery, radiotherapy, and chemotherapy) on seizure control has mainly been demonstrated in low-grade glioma. AED prophylaxis in seizure-naïve BTRE patients is not recommended, but AED treatment should be initiated after a first seizure has occurred. Comparative efficacy randomized controlled trials (RCTs) are currently lacking, but second-generation AED levetiracetam seems the preferred choice in BTRE. Levetiracetam lacks significant drug-drug interactions, has shown favorable efficacy compared to valproic acid in BTRE, generally causes no hematological or neurocognitive functioning adverse effects, but caution should be exercised with regard to psychiatric adverse effects. Potential add-on AEDs in case of uncontrolled seizures include lacosamide, perampanel, and valproic acid. Ultimately, in the end-of-life phase when oral intake of medication is hampered, benzodiazepines via nonoral administration routes are potential alternatives. SUMMARY: Management of seizures in BTRE is complex and with currently available evidence levetiracetam seems the preferred choice. Comparative efficacy RCTs in BTRE are warranted. Lippincott Williams & Wilkins 2022-11 2022-07-16 /pmc/articles/PMC9594141/ /pubmed/35838207 http://dx.doi.org/10.1097/CCO.0000000000000876 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/)
spellingShingle BRAIN AND NERVOUS SYSTEM: Edited by Marc Sanson and Anna-Luisa Di Stefano
van der Meer, Pim B.
Taphoorn, Martin J.B.
Koekkoek, Johan A.F.
Management of epilepsy in brain tumor patients
title Management of epilepsy in brain tumor patients
title_full Management of epilepsy in brain tumor patients
title_fullStr Management of epilepsy in brain tumor patients
title_full_unstemmed Management of epilepsy in brain tumor patients
title_short Management of epilepsy in brain tumor patients
title_sort management of epilepsy in brain tumor patients
topic BRAIN AND NERVOUS SYSTEM: Edited by Marc Sanson and Anna-Luisa Di Stefano
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9594141/
https://www.ncbi.nlm.nih.gov/pubmed/35838207
http://dx.doi.org/10.1097/CCO.0000000000000876
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