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Management of epilepsy in brain tumors

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Abstract

Epilepsy in brain tumors (BTE) may require medical attention for a variety of unique concerns: epileptic seizures, possible serious adverse effects of antineoplastic and antiepileptic drugs (AEDs), physical disability, and/or neurocognitive disturbances correlated to tumor site. Guidelines for the management of tumor-related epilepsies are lacking. Treatment is not standardized, and overall management might differ according to different specialists. The aim of this document was to provide directives on the procedures to be adopted for a correct diagnostic-therapeutic path of the patient with BTE, evaluating indications, risks, and benefits. A board comprising neurologists, epileptologists, neurophysiologists, neuroradiologists, neurosurgeons, neuro-oncologists, neuropsychologists, and patients’ representatives was formed. The board converted diagnostic and therapeutic problems into seventeen questions. A literature search was performed in September–October 2017, and a total of 7827 unique records were retrieved, of which 148 constituted the core literature. There is no evidence that histological type or localization of the brain tumor affects the response to an AED. The board recommended to avoid enzyme-inducing antiepileptic drugs because of their interference with antitumoral drugs and consider as first-choice newer generation drugs (among them, levetiracetam, lamotrigine, and topiramate). Valproic acid should also be considered. Both short-term and long-term prophylaxes are not recommended in primary and metastatic brain tumors. Management of seizures in patients with BTE should be multidisciplinary. The panel evidenced conflicting or lacking data regarding the role of EEG, the choice of therapeutic strategy, and timing to withdraw AEDs and recommended high-quality long-term studies to standardize BTE care.

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Authors and Affiliations

  1. Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy

    Marta Maschio, Andrea Maialetti & Alessia Zarabla

  2. Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy

    Umberto Aguglia & Sara Gasparini

  3. Department of Neurophysiology and Experimental Epileptology, Carlo Besta Neurological Institute, Milan, Italy

    Giuliano Avanzini

  4. Neurology Unit, Department of Emergency, Medicine Epilepsy Center, Circolo Hospital, Varese, Italy

    Paola Banfi

  5. Department of Neuroscience, Mental Health and Sensory Organs, University of Rome “La Sapienza”, Rome, Italy

    Carla Buttinelli

  6. Department of Mental Health, Epilepsy Center, C. Poma Hospital, Mantua, Italy

    Giuseppe Capovilla

  7. Neurophysiopatology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy

    Marina Maria Luisa Casazza

  8. Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy

    Gabriella Colicchio

  9. Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy

    Antonietta Coppola

  10. Neurological Clinic, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy

    Cinzia Costa

  11. Epilepsy Centre, UOC Neurology, SS. Giovanni e Paolo Hospital, Venice, Italy

    Filippo Dainese

  12. Epilepsy Center-U.O.C. Neurology, Policlinico Paolo Giaccone, Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy

    Ornella Daniele

  13. Neurology and Stroke Unit, Epilepsy and Sleep Disorders Center, St. Eugenio Hospital, Rome, Italy

    Roberto De Simone

  14. Molecular Neuro-Oncology Unit, IRCCS-Fondazione Istituto Neurologico Carlo Besta, Milan, Italy

    Marica Eoli

  15. Neurology Unit, Human Neurosciences Department, Sapienza University, Rome, Italy

    Anna Teresa Giallonardo

  16. Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy

    Angela La Neve

  17. Neurology Unit, Human Neurosciences Department, Sapienza University, Umberto 1 Hospital, Rome, Italy

    Oriano Mecarelli

  18. Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, Monserrato, Cagliari, Italy

    Marta Melis

  19. Unit of Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Roberto Michelucci

  20. Epilepsy Center, UOC Neurology, Ospedale Santi Giovanni e Paolo, Venice, Italy

    Francesco Paladin

  21. Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy

    Giada Pauletto

  22. UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy

    Marta Piccioli

  23. USC Neurology, Epilepsy Center, ASST Papa Giovanni XXIII, Bergamo, Italy

    Stefano Quadri

  24. Epilepsy Centre, Neuroscience Department, S. Bortolo Hospital, Vicenza, Italy

    Federica Ranzato

  25. Neurology and Stroke Unit, San Francesco Hospital, 08100, Nuoro, Italy

    Rosario Rossi

  26. Neurological Department, ASST, Lecco, Italy

    Andrea Salmaggi

  27. Epilepsy Consultation Room, Neurology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy

    Riccardo Terenzi

  28. Neurophysiology Unit, Department of Neurology-University “La Sapienza”, S. Andrea Hospital, Rome, Italy

    Paolo Tisei

  29. Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy

    Flavio Villani

  30. Neuroradiology and Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy

    Paolo Vitali

  31. Epilepsy Consultation Room, U.O.C. Neurology, Rivoli Hospital, Turin, Italy

    Lucina Carla Vivalda

  32. Regional Health Agency of Tuscany, Via P Dazzi 1, 50141, Florence, Italy

    Gaetano Zaccara

  33. Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

    Ettore Beghi

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Consortia

On behalf of Brain Tumor-related Epilepsy study group of Italian League Against Epilepsy (LICE)

Corresponding author

Correspondence to Marta Maschio.

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Conflict of interest

Dr. Marta Maschio has received support to travel to congresses from Eisai Srl, has participated in scientific advisory boards for Eisai Srl, has participated in pharmaceutical industry sponsored symposia for UCB Pharma, and has received research grants from UCB Pharma. Dr. Angela La Neve has received speaker’s or consultancy fees from Eisai Srl, Mylan, Sanofi-Aventis, and UCB Pharma. Dr. Gaetano Zaccara has received speaker’s or consultancy fees from Eisai Srl, Sanofi-Aventis, and UCB Pharma. Dr. Cinzia Costa has received speaker’s or consultancy fees from Eisai Srl, FIDIA, Mylan, and UCB. Dr. Filippo Dainese has received speaker’s or consultancy fees from Eisai and UCB Pharma. Dr. Umberto Aguglia has received research grants from Biogen. Dr. Ettore Beghi has received grants from UCB Pharma and grants from Italian Ministry of Health. Dr. Federica Ranzato has participated in hospital meetings and sponsored symposia from UCB Pharma and Eisai Srl.00. The other authors declare that they have no conflict of interest.

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Aguglia Umberto is a coordinator and delegate for the Epilepsy Study Group of the Italian Neurological Society—SIN.

Electronic supplementary material

ESM 1

Details about panel members and role. (DOCX 24 kb)

ESM 2

Literature search strategy. (DOCX 177 kb)

ESM 3

Complete list of point questions (collected in domains) and of the assigned literature (DOCX 114 kb)

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Maschio, M., Aguglia, U., Avanzini, G. et al. Management of epilepsy in brain tumors. Neurol Sci 40, 2217–2234 (2019). https://doi.org/10.1007/s10072-019-04025-9

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