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原发性与转移性脑肿瘤患者的癫痫发作

Authors
Jan Drappatz, MD
Patrick Y Wen, MD
Edward K Avila, DO
Section Editors
Jerome B Posner, MD
Timothy A Pedley, MD
Deputy Editor
Janet L Wilterdink, MD
Translators
范薇, 主任医师

引言

癫痫发作是原发性和转移性脑肿瘤两者的常见且具有潜在破坏性的并发症[1]。此类癫痫发作的开始是局灶性发作，随后可能保持局灶性发作或为继发性全面性发作。癫痫发作的诊断通常是临床诊断。

脑肿瘤患者癫痫发作的流行病学和治疗、预防性使用抗癫痫药物(antiepileptic drug, AED)以及治疗的并发症将总结在此。脑肿瘤的临床表现和癫痫发作的一般处理将在别处讨论。 (参见“脑肿瘤的临床表现和诊断”，关于‘临床表现’一节和“成人癫痫处理概述”)

流行病学

癫痫发作是脑肿瘤患者的相对常见的问题。癫痫发作可能是脑肿瘤的初始表现或可能出现在疾病病程中。 (参见“脑肿瘤的临床表现和诊断”，关于‘癫痫发作’一节)

影响癫痫发作发病率的因素包括肿瘤类型和位置：

●在原发性脑肿瘤患者中，高级别胶质瘤比低级别胶质瘤较少出现癫痫发作[2]。例如，在一项纳入1028例原发性脑肿瘤患者的病例系列研究中，胶质母细胞瘤(glioblastoma, GBM)、间变性胶质瘤和低级别胶质瘤患者的癫痫患病率分别为49%、69%和85%[3]。然而，在一项纳入75例高级别胶质瘤患者进行仔细研究的病例系列研究中，在诊断时35例患者(52%)有癫痫发作，而60例患者(80%)在疾病病程中的某个时间发生癫痫发作[4]。已提出假设认为脑星形细胞瘤周围区域腺苷激酶的调节异常在脑肿瘤相关的癫痫发作中起一定作用[5]。

                

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-28.
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