Tumorassoziierte Epilepsie bei Gliomen

Epileptic seizures are common symptoms among patients with low- and high-grade glioma. They are associated with a poor quality of life and a higher rate of complications. Patients with low-grade glioma have a higher seizure rate than patients with high-grade tumors. New pathophysiologic insights into tumor biology and its complex interactions with the surrounding brain tissue have revealed that tumor growth is enhanced by neuronal hyperexcitability. Therefore, brain tumor-related epilepsy could promote tumor progression. Tumor mass reduction, by surgery or chemo- and/or radiotherapy, can significantly reduce the seizure rate. Furthermore, initiation of anti-seizure medication (ASM) is indicated upon diagnosis of brain tumor-related epilepsy. The choice of ASM depends on factors such seizure type, mode of action, comorbidities, and especially the side effects of these drugs. In Europe, levetiracetam is the preferred choice for monotherapy. Consensus exists that first-generation ASM should be avoided, if possible, due to their strong enzyme-modulatory effects accounting for potential interactions with tumor treatment and other drugs. A statement on possible antiproliferative effects of ASM with an effect of tumor growth cannot be made based on the current state of evidence. In general, recommendations argue against prophylactic ASM treatment. The duration as well as the timepoint of cessation of ASM treatment in glioma patients is decided on an individual basis according to a strict risk–benefit assessment. More studies with head-to-head comparisons of different ASM are needed for a better understanding of the effectiveness as well as the tolerability of ASM treatment regimes in patients with brain tumor-associated epilepsy.