Brain tumor epilepsy: a reappraisal and six remaining issues to be debated

Epilepsy associated with brain tumors presents with specific features deserving medical attention. Although commonly reported in patients with brain tumor, either as revealing mode or as a remote complication, limited knowledge is available regarding their epidemiology, clinical evolution, surgical outcome, physiopathology and treatment, providing only clues for clinical management. Seizures appear even more threatening for patients and caregivers, providing seizures could mean tumor progression and recurrence. This factor adds to the negative impact of epilepsy carried on quality of life measures. Pharmacotherapy is complicated by the use of chemotherapy and interaction between antiepileptic drugs and antineoplastic agents are frequent and potentially harmful. The high incidence of epilepsy enlights the question of prophylaxy with antiepileptic drugs, in patients without seizures, or during the perioperative period, and after surgery, when gross total resection has been achieved. This article attempts to provide the reader with an overview of brain tumor epilepsy in its specific aspects and to comment on some remaining issues.