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Seizures as Complications in Cancer

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Cancer Neurology in Clinical Practice

Abstract

In cancer, epilepsy can be the manifestation of a primary brain tumor, metastasis, opportunistic infection, vascular or surgical complications or secondary to antitumor therapy. Often, a single seizure is the presenting symptom of a brain tumor; such patients usually have a better prognosis for survival compared to those presenting with other neurological symptoms. With gliomas, the tumor type bears upon both initial epilepsy frequency as well as the risk of seizure recurrence. Anti-tumor treatment with surgery, radiotherapy and chemotherapy strongly influences seizure control. Symptomatic management of brain tumor related epilepsy (BTE) is based upon evidence-based selection of antiepileptic drugs indicated for focal epilepsy in adults, individualized according to patient factors including co-morbidity and concomitant therapy. Levetiracetam followed by lacosamide and valproic acid are typically the agents of choice, and can be combined if necessary. When such mono- or polytherapy is ineffective or produces side effects, lamotrigine, perampanel or zonisamide are other good choices. Evidence to support AED prophylaxis is lacking with exception of the perioperative period. In neuro-oncology, the most prevalent side effects of AEDs are cognitive dysfunction, bone marrow toxicity and skin hypersensitivity reactions. As combined treatment with anti-epileptic drugs and cytotoxic or targeted chemotherapy is the rule rather than the exception, drug–drug interactions are a concern. Plasma monitoring of AEDs helps in detecting drug insufficiency, toxicity or interactions and to apply proper dose regimens.

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Authors and Affiliations

  1. Department of Neurology, The Hague Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands

    Christa P. Benit & Melissa Kerkhof

  2. Department of Neurology Mazarin, Pitié Salpetrière Hospital, 47 Boulevard de l’hôpital, 75013, Paris, France

    Alberto Duran-Peña & Charles J. Vecht

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  1. Christa P. Benit
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  4. Charles J. Vecht
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  1. Harrison Distinguished Teaching, Professor of Neurology, Neurological Surgery, and Medicine, University of Virginia, Charlottesville, Virginia, USA

    David Schiff

  2. Instructor, Harvard Medical School, Massachusetts General Hospital, Department of Neurology/Neuro-Oncology, Boston, Massachusetts, USA

    Isabel Arrillaga

  3. Professor of Neurology, Harvard Medical School, Dana-Farber/Brigham and Women’s Cancer Center, Center for Neuro-Oncology, Boston, Massachusetts, USA

    Patrick Y. Wen

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Benit, C.P., Kerkhof, M., Duran-Peña, A., Vecht, C.J. (2018). Seizures as Complications in Cancer. In: Schiff, D., Arrillaga, I., Wen, P. (eds) Cancer Neurology in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-57901-6_9

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