Pathophysiology and antiepileptic drug therapy in tumor-associated epilepsy and its implications in status epilepticus

Goonawardena, J. (2011) Pathophysiology and antiepileptic drug therapy in tumor-associated epilepsy and its implications in status epilepticus. Epilepsia, 52 (s8). p. 77.

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Abstract

Introduction: Seizures occur in 20–45% of patients with brain tumors. They are also at risk of developing status epilepticus (SE). This reinforces the importance of adequate therapeutic management of tumor-associated epilepsy (TAE).

Method: A retrospective chart review was done, of twenty patients who presented with TAE from 2006 to 2009. The type and location of the tumor, type of seizure experienced, choice of antiepileptic drugs (AEDs) were noted. A literature review was undertaken. MEDLINE was searched for systematic reviews from 1950 to 2010, twenty-eight journal articles were selected. Comparisons were made between the retrospective chart review and the literature review. Treatment complications and implications in SE were investigated.

Results: Multifactorial pathophysiological mechanisms involving a complex interplay between histological, anatomical, biochemical, physiological and genetic factors have been suggested. Contrary to literature, complex partial seizures (30%) were more common compared to simple partial seizures (10%). Similar to literature, lesions in the frontal (35%) and temporal (50%) lobes had the highest epileptogenecity compared to the occipital (5%) lobe. SE occurred in 15% of the patients. Even though valproate and levetiracetam was the best combination of AEDs suggested, it was only used in 10% of patients. Instead valproate and phenytoin were used (20%). Phenytoin was preferred in SE (66%) and in monotherapy (25%) instead of Levetiracetam. However treatment complications exist.

Conclusion: The best choice of AEDs remains controversial due to the underlying pathophysiological complexity. Type of seizure, treatment complications and individual patient factors therefore need to be considered. Development of novel therapies targeting multiple pathophysiological mechanisms coupled with intrinsic antineoplastic activity would be desirable.

Item ID: 21749
Item Type: Article (Abstract)
Additional Information:

Epilepsia, Volume 52, Issue Supplement s8, pages 72–85, October 2011.

Special Issue: Proceedings of the 3rd London-Innsbruck Colloquium on Acute Seizures and Status Epilepticus

ISSN: 1528-1167
Date Deposited: 14 May 2012 05:22
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1109 Neurosciences > 110999 Neurosciences not elsewhere classified @ 30%
11 MEDICAL AND HEALTH SCIENCES > 1112 Oncology and Carcinogenesis > 111299 Oncology and Carcinogenesis not elsewhere classified @ 30%
11 MEDICAL AND HEALTH SCIENCES > 1115 Pharmacology and Pharmaceutical Sciences > 111502 Clinical Pharmacology and Therapeutics @ 40%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920111 Nervous System and Disorders @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920102 Cancer and Related Disorders @ 50%
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