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Optimizing therapy of seizures in
patients with brain tumors
Charles J. Vecht, MD, PhD
and Melanie van Breemen, MD
From the Department of Neurology,
Medical Center The Hague, The Hague, The Netherlands. -- Address
correspondence and reprint requests to Dr. Charles J. Vecht,
Department of Neurology, Medical Center The Hague, POB 432, 2501 CK
The Hague, The Netherlands; e-mail: c.vecht@mchaaglanden.nl
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The mechanism of epilepsy in brain tumor
patients is probably multifactorial, and its incidence
depends on tumor type and location.
Refractory epilepsy is common in patients
with structural brain lesions, and a role for multidrug-resistance
proteins has been suggested.
The medical treatment of epilepsy in brain
tumor patients has mainly been studied retrospectively, and
the optimal management of seizures with antiepileptic drugs
(AEDs) is unclear.
Enzyme-inducing anticonvulsants are
generally not recommended because they can lead to
insufficient serum levels of concomitantly administered
chemotherapeutic drugs.
Although valproic acid is an enzyme
inhibitor and may therefore lead to toxic levels of
simultaneously administered chemotherapeutic agents, this
does not appear to be a major problem in patients with
brain tumors.
Preliminary observations of add-on
treatment with the AEDs levetiracetam or gabapentin suggest
that these non-enzyme-inducing AEDs can be useful for
control of seizures in patients with brain tumors.
Conversely, prophylactic use of
AEDs in brain tumor patients is generally not recommended.
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