Seizures and Anticonvulsants in Brain Tumours: Frequency, Mechanisms and Anti-Epileptic Management.

Seizures and Anticonvulsants in Brain Tumours: Frequency, Mechanisms and Anti-Epileptic Management. Curr Pharm Des. 2017 Oct 27;: Authors: Vecht C, Royer-Perron L, Houillier C, Huberfeld G Abstract In cancer, epilepsy can be the manifestation of a primary brain tumour, metastatic disease, vascular or surgical complications, opportunistic infection or secondary to anti-tumour therapy. Seizures are frequently the first symptom of a brain tumour. The epilepsy is related to elevated extracellular glutamate stimulating NMDA- and AMPA-receptors and to the formation of D-2HG which resembles glutamate in IDH1 mutated gliomas. Epilepsy as presenting sign is associated with a longer survival in low- and high- grade gliomas, particularly with the IDH1 mutation. Anti-tumour treatment by surgery, radiotherapy or chemotherapy strongly contributes to seizure control. Symptomatic management of brain tumour-related epilepsy (BTE) by evidenced-based anti-epileptic drugs (AEDs) as indicated for focal epilepsy depends on individual patient factors including age, sex, weight, co-morbidity and co-therapy. Levetiracetam followed by lacosamide or valproic acid are the agents of choice. Both can be combined with levetiracetam in case monotherapy is inactive or produces side-effects. Lamotrigine, perampanel, zonisamide or clobazam are other good choices. On seizure prophylaxis, there is some evidence for its application in the peri-operative period. The most ...
Source: Current Pharmaceutical Design - Category: Drugs & Pharmacology Authors: Tags: Curr Pharm Des Source Type: research