Seizures in patients with primary and metastatic brain tumors
- Jan Drappatz, MD
Jan Drappatz, MD
- Associate Director
- Adult Neuro-Oncology Program
- Associate Professor
- Departments of Neurology and Medicine
- University of Pittsburgh
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
- Edward K Avila, DO
Edward K Avila, DO
- Assistant Professor of Neurology
- Memorial Sloan-Kettering Cancer Center
- Section Editors
- Timothy A Pedley, MD
Timothy A Pedley, MD
- Editor-in-Chief — Neurology
- Section Editor — Epilepsy
- Henry and Lucy Moses Professor of Neurology
- Columbia University College of Physicians and Surgeons
- Lisa M DeAngelis, MD, FAAN, FANA
Lisa M DeAngelis, MD, FAAN, FANA
- Section Editor — Neurooncology
- Chair, Department of Neurology
- Lillian Rojtman Berkman Chair in Honor of Jerome B. Posner
- Memorial Sloan Kettering Cancer Center
Seizures are a common and potentially devastating complication of both primary and metastatic brain tumors . Such seizures are focal in origin and may either remain focal or secondarily generalize. The diagnosis of a seizure disorder is usually made clinically.
The epidemiology and treatment of seizures, prophylactic use of antiseizure drugs, and complications of therapy in patients with brain tumors will be reviewed here. The clinical manifestations of brain tumors and the general management of seizures are discussed elsewhere. (See "Overview of the clinical features and diagnosis of brain tumors in adults", section on 'Clinical manifestations' and "Overview of the management of epilepsy in adults".)
Seizures are a relatively common problem in patients with brain tumors. Seizures may be the initial manifestation of a brain tumor or may occur during the course of disease. (See "Overview of the clinical features and diagnosis of brain tumors in adults", section on 'Seizures'.)
The main factors that influence the incidence of seizures are tumor type, grade, and location:
●Among patients with primary brain tumors, seizures are more common with low-grade tumors than with high-grade tumors . The prevalence rates of epilepsy in a series of 1028 patients with primary brain tumors were 85, 69, and 49 percent among patients with low-grade glioma, anaplastic glioma, and glioblastoma, respectively . Other studies have found that at least one seizure occurs in up to 80 percent in patients with high-grade glioma at some time during the course of disease .
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- CLINICAL MANIFESTATIONS
- Nonconvulsive status epilepticus
- DIAGNOSTIC EVALUATION
- Antiseizure drug therapy
- Tumor-directed therapies
- Patients without a history of a seizure
- Postoperative prophylaxis
- ADVERSE EFFECTS OF ANTISEIZURE DRUG THERAPY
- Side effects
- - Drug rash
- Drug-drug interactions
- SEIZURES AT THE END OF LIFE
- SUMMARY AND RECOMMENDATIONS