Seizures and epilepsy in cancer: Etiologies, evaluation, and management

Grewal, Jai; Grewal, Harpreet; Forman, Arthur D.

doi:10.1007/s11912-008-0010-2

Cited by 32 publications

(22 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 Additionally, levetiracetam lacks any significant effects on the metabolism of medications via hepatic enzymes (cytochrome P450, glucuronidation, etc) and is often a preferred agent because of the decreased likelihood of adverse interactions and subsequent toxicities. 7 A possible mechanism responsible for decreased MTX elimination when coadministered with levetiracetam has not been proposed; however, it may be because of competition for tubular secretion. Though levetiracetam undergoes glomerular filtration, the metabolite ucb L057 is eliminated via active tubular secretion.…”

Section: Discussionmentioning

confidence: 99%

Drug-Drug Interaction Between Methotrexate and Levetiracetam Resulting in Delayed Methotrexate Elimination

2013

View full text Add to dashboard Cite

Objective: To report a case of delayed methotrexate (MTX) elimination while receiving concomitant levetiracetam. Case Report: A 46-year-old man with relapsed osteosarcoma of the base of the skull receiving high-dose MTX tolerated his first cycle of MTX with elimination to nontoxic MTX levels (≤0.1 µmol/L) within 90 hours. After hospital discharge, the patient experienced seizures secondary to brain metastasis and started on levetiracetam, which was continued as maintenance therapy. The patient experienced delayed MTX elimination during cycles 2, 3, and 4 while receiving levetiracetam. On average, elimination to nontoxic MTX levels took 130 hours (106-144 hours). Before the fifth cycle of MTX, lorazepam was substituted for the levetiracetam. MTX was eliminated to nontoxic levels within 95 hours. During all cycles, the patient received standard supportive care and serum creatinine remained stable. No other drugs known to interact with MTX were administered. Discussion: This possible drug interaction has only been reported once in the pediatric population. With a score of 6 on the Drug Interaction Probability Scale for evaluating causation of drug interactions, it is probable that the delayed MTX elimination was caused by an interaction with levetiracetam. Conclusion: Coadministration of levetiracetam and MTX may result in delayed elimination of MTX, increasing the likelihood of toxicity. Consideration should be given to temporarily switching from levetiracetam to another antiepileptic (ie, lorazepam) to prevent this interaction. This is particularly important in those experiencing delayed elimination with prior cycles of concomitant MTX and levetiracetam or those at greater risk for MTX toxicity.

show abstract

Section: Discussionmentioning

confidence: 99%

Drug-Drug Interaction Between Methotrexate and Levetiracetam Resulting in Delayed Methotrexate Elimination

2013

View full text Add to dashboard Cite

show abstract

“…However, up to 30% will develop seizures later in the course of their disease [2]. In the cancer population seizures can occur for numerous reasons including primary brain tumors, brain metastasis, paraneoplastic syndromes, and other etiologies such as toxic/metabolic, infection, or from a reaction to cancer treatment [3]. Drug interactions and adverse drug effects are important considerations in this population as many treatments may have neurologic adverse effects and seizures are one such problem.…”

Section: Incidencementioning

confidence: 99%

Tumor Associated Epilepsy

Avila¹

2013

Clinical Management and Evolving Novel Therapeutic Strategies for Patients With Brain Tumors

View full text Add to dashboard Cite

Epilepsy in the general population occurs with an incidence of per , person-years in a population based study [ ]. Symptomatic etiologies such as vascular injuries, infection, and neoplasm are usually associated with a higher incidence of seizures and epilepsy. In the cancer population, seizures arise mainly as a result of an infiltrative neoplastic process in the brain. However, cancer treatment, metabolic causes, and paraneoplastic disease can also cause seizures in this population despite the absence of a structural lesion. The etiology of epilepsy in brain tumor patients includes primary malignancies and metastatic disease to the brain. A multifaceted approach is required for treatment of seizures including surgery, radiation treatment, chemotherapy, and antiepileptic drugs. A combination of treatments has the potential of adverse effects and generally requires a multidisciplinary team. This chapter will review the causes of epilepsy in cancer patients, incidence, treatment, the role of electroencephalogram EEG and antiepileptic prophylaxis in this group of patients. The factors which predispose seizures in these patients will also be reviewed, such as tumor grade, histology and brain tumor morphology.

show abstract

“…Epileptic seizures may occur in patients with systemic cancer for a variety of reasons [1]. Primary and metastatic brain tumors are frequently complicated by symptomatic epilepsy, defined as recurrent unprovoked seizures or single isolated seizure episode, both associated to the brain lesion.…”

Section: Introductionmentioning

confidence: 99%