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Epilepsy in CNS Metastases

  • Roberta Rudà
  • Alessia Pellerino
  • Riccardo Soffietti
Chapter

Abstract

According to new data from MRI era, seizures represent the new-onset symptom in about 15% of patients with brain metastases. Most patients develop seizures at the time of presentation (78%), while a minority (22%) develop seizures later in the course of the disease. Among the most frequent tumor types, the highest rate for seizures is observed in melanoma followed by lung cancer patients. Among less frequent primary tumors, seizure risk seems relatively high for ovarian cancers and low for colorectal and prostate cancers. Very few is known concerning the pathogenesis of epilepsy in brain metastases. Prophylaxis with antiepileptic drugs for patients with brain metastases without a history of seizures is not recommended. There is no evidence that a specific antiepileptic drug is more effective than the another one, but due to the risk of interactions between AEDs and anticancer agents, enzyme-inducing AEDs should be avoided: thus, levetiracetam and valproic acid are the most appropriate AEDs. Total resection of a brain metastasis could allow complete seizure control. Conversely, seizures may represent an adverse effect of stereotactic radiosurgery in up to 12% of patients. Seizures may occur following high-dose chemotherapy.

Keywords

Brain metastases Seizures Epilepsy Antiepileptic drugs Interactions 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Roberta Rudà
    • 1
  • Alessia Pellerino
    • 1
  • Riccardo Soffietti
    • 1
  1. 1.Department of Neuro-OncologyUniversity and City of Health and Science HospitalTurinItaly

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