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Epilepsy in CNS Metastases

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Central Nervous System Metastases

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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.

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Authors and Affiliations

  1. Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy

    Roberta Rudà, Alessia Pellerino & Riccardo Soffietti

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  1. Roberta Rudà
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  2. Alessia Pellerino
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  3. Riccardo Soffietti
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Editor information

Editors and Affiliations

  1. Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Manmeet Ahluwalia

  2. Department of Neurosurgery and Neuro-Oncology, Clairval Hospital Center, Ramsay-Générale de Santé, Marseille, France, Neurophysiopathology Institute, Aix-Marseille Université, Marseille, France

    Philippe Metellus

  3. Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy

    Riccardo Soffietti

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Rudà, R., Pellerino, A., Soffietti, R. (2020). Epilepsy in CNS Metastases. In: Ahluwalia, M., Metellus, P., Soffietti, R. (eds) Central Nervous System Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-23417-1_9

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  • DOI: https://doi.org/10.1007/978-3-030-23417-1_9

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