Epilepsy in brain tumor patients

This review focuses on anticonvulsant treatments in patients with brain tumors and epilepsy, in consideration of the rapidly expanding spectrum of these agents.

Despite the fact that this clinical condition is frequent, scarce evidence is available on this topic. Current American Association of Neurology practice parameters, published a decade ago, discourage the prescription of prophylactic anticonvulsant treatment; this should, however, be implemented after a first seizure in view of the high recurrence risk. Several observational series describe the use of newer anti-epileptic compounds in this clinical setting, suggesting that these should be preferred to traditional anticonvulsants in view of their safety regarding pharmacokinetic interactions and better tolerability. In particular, levetiracetam and pregabalin seem promising. Anti-epileptic treatment leads to a complete control or a marked reduction of seizures in most patients with brain tumors; however, there is currently no evidence that efficacy is different among all marketed anti-epileptic drugs.

Despite the lack of high-level evidence data, the use of anticonvulsants devoid of pharmacokinetic interactions should be recommended in patients with epilepsy symptomatic of brain tumors. Prospective, comparative studies are needed to address open questions regarding the role of specific agents and optimal treatment duration.