Tumor-Associated Epilepsy in Patients with Glioma

Abstract

Epileptic seizures are common symptoms in patients with glioma, occurring at disease presentation as well as during later disease. The frequency of tumor-related seizures is strongly related to the growth rate of the tumor. In low-grade gliomas, seizures as initial symptom leading to the brain tumor diagnosis occur in 70–90% of all patients. About 50% of these patients continue to have seizures before operation in spite of optimal antiepileptic drug treatment. In high-grade gliomas, seizures at disease presentation are less frequent and occur in only 30–50% of all patients but may be more difficult to control. Apart from the tumor growth rate, the specific location of the tumor in the brain and its proximity to the cortex affect seizure risk and seizure control in glioma. For many patients with tumor-related seizures, optimal seizure control is not achieved by antiepileptic drugs only but requires additional therapy such as surgical resection and/or radio- and chemotherapy. In this review, we discuss different aspects of the clinical presentation of the disease in patients with tumor-related seizures. We also discuss the possible therapeutic strategies for patients with medically refractory seizures, illustrating the importance of a qualified specialized team of neuro-oncologists, neurologists and neurosurgeons for the optimal management of this patient group.