Antiseizure Drugs for Tumor-Related Epilepsy Require Careful Management

The typical treatment for patients with brain tumor-related epilepsy is antiseizure medication in conjunction with tumor resection surgery and/or chemoradiotherapy, according to a Society for Neuro-Oncology consensus review published in Neuro-Oncology.

“Often a seizure is the presenting symptom of a brain neoplasm. Seizure control often aligns with tumor growth and conversely can improve with tumor-directed treatment,” wrote corresponding author Edward K. Avila, DO, of the Memorial Sloan Kettering Cancer Center Department of Neurology, New York, New York, and coauthors of the review.

The review covers current practices for the management of tumor-related epilepsy with antiseizure medication, surgery, chemotherapy, radiotherapy, and targeted therapy.

According to the review, more than 20 antiseizure medications have been developed over the last 30 years. First-, second- and third-generation antiseizure medications are available. When choosing an antiseizure medication, consideration of comorbid conditions and potential adverse effects is essential.

“These agents carry a potential for drug–drug interactions,” the authors wrote, “and therefore knowledge of mechanisms of action and interactions is needed.”

To optimize medication regimens, prescribers should review adverse effects regularly and distinguish between medication-related side effects and those from oncologic treatments or underlying disease. Familiarity with common side effects of specific antiseizure drugs, such as fatigue, dizziness, nausea, and depression, can help.

The most effective treatment for tumor-related epilepsy is usually surgical excision of the tumor, the review stated. For the majority of pathologies, gross-total resection best predicts freedom from postoperative seizures.

“Further advances in identifying seizure-related biomarkers and mechanisms across tumor pathologies will facilitate targeted treatment strategies impacting both oncologic and epilepsy outcomes,” the authors advised.

Reference

Avila EK, Tobochnik S, Inati SK, et al. Brain tumor-related epilepsy management: a Society for Neuro-Oncology (SNO) consensus review on current management. Neuro Oncol. 2024;26(1):7-24. doi:10.1093/neuonc/noad154