Management of epileptic seizures

Acquired epileptic seizures are common in cancer patients. They heavily impact on the quality of life and may affect survival. Most patients are medically treated, but the use of antiepileptic drugs (AEDs) in neuro-oncology is complicated by serious specific side effects and interference of AEDs with other commonly prescribed drugs such as chemotherapeutic agents and corticosteroids. The main purpose of this review is to help the clinician to select the most appropriate drug or drug combination, and to minimize drug side effects and drug interactions in epilepsy treatment of cancer patients.

Considerable progress has been achieved recently in epileptology. They include the development of new AEDs and better understanding of their subcellular mechanism of action and of drug interactions. Most studies concerning the efficacy of AEDs have not been performed specifically in neuro-oncological patients, and the extrapolation of their results to tumor-related epilepsy requires some caution. The most significant findings specific to tumor-related epilepsy are (a) the indication that their pathogenesis may be due to a decrease of focal GABA-ergic inhibition, and (b) the guidelines for prophylaxis based on a report by a subcommittee of the American Academy of Neurology.

The quality of life of epileptic patients has been improved by both a better control of seizures and the use of drugs with fewer side effects. Cancer patients probably benefit from this progress. However, treatment of tumor-related epilepsy faces several specific problems, and there is a real need for conducting clinical trials restricted to cancer patients.