An overview of anti-epileptic therapy management of patients with malignant tumors of the brain undergoing radiation therapy

•Prophylactic anti-epileptic drug use is currently not recommended in brain tumor patients.•During cranial radiation, prophylactic anticonvulsant use is not recommended.•Concurrent cranial radiation and anticonvulsants can cause severe skin toxicity.•Radiation treatment of gliomas reduces seizure in...

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Veröffentlicht in:Seizure (London, England) England), 2019-08, Vol.70, p.30-37
Hauptverfasser: Julie, Diana A.R., Ahmed, Zartaj, Karceski, Stephen C., Pannullo, Susan C., Schwartz, Theodore H., Parashar, Bhupesh, Wernicke, A. Gabriella
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Sprache:eng
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Zusammenfassung:•Prophylactic anti-epileptic drug use is currently not recommended in brain tumor patients.•During cranial radiation, prophylactic anticonvulsant use is not recommended.•Concurrent cranial radiation and anticonvulsants can cause severe skin toxicity.•Radiation treatment of gliomas reduces seizure incidence.•Evidence of anti-tumor effects of anticonvulsants in glioblastoma is inconclusive. As our surgical, radiation, chemotherapeutic and supportive therapies for brain malignancies improve, and overall survival is prolonged, appropriate symptom management in this patient population becomes increasingly important. This review summarizes the published literature and current practice patterns regarding prophylactic and perioperative anti-epileptic drug use. As a wide range of anti-epileptic drugs is now available to providers, evidence guiding appropriate anticonvulsant choice is reviewed. A particular focus of this article is radiation therapy for brain malignancies. Toxicities and seizure risk associated with cranial irradiation will be discussed. Epilepsy management in patients undergoing radiation for gliomas, glioblastoma multiforme, and brain metastases will be addressed. An emerging but inconsistent body of evidence, reviewed here, indicates that anti-epileptic medications may increase radiosensitivity, and therefore improve clinical outcomes, specifically in glioblastoma multiforme patients.
ISSN:1059-1311
1532-2688
DOI:10.1016/j.seizure.2019.06.019