Status epilepticus secondary to glioma

Knudsen-Baas, Kristin M.; Power, Kjersti Nesheim; Engelsen, Bernt A.; Hegrestad, S.E.; Gilhus, Nils Erik; Storstein, Anette

doi:10.1016/j.seizure.2016.06.013

Cited by 19 publications

(11 citation statements)

References 41 publications

(28 reference statements)

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“…The appearance of tumor-associated status epilepticus (TASE) can indicate tumor progression [5,15]. In half of the patients with glioma, status epilepticus is due to other factors such as non-adherence to medication or intercurrent conditions, for instance infections or electrolyte disturbances [16]. A study from 2021 showed that the semiology of TASE was more commonly complex focal (74%) and less commonly generalized convulsive (17%) [5].…”

Section: Status Epilepticusmentioning

confidence: 99%

Seizure Management and Prophylaxis Considerations in Patients with Brain Tumors

Hauff

Storstein

2023

Curr Oncol Rep

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Purpose of Review The article gives an overview of the current knowledge in the management of tumor related epilepsy, including systematic reviews and consensus statements as well as recent insight into a potentially more individualized treatment approach. Recent Findings Tumor molecular markers as IDH1 mutation and MGMT methylation status may provide future treatment targets. Seizure control should be included as a metric in assessing efficacy of tumor treatment. Summary Prophylactic treatment is recommended in all brain tumor patients after the first seizure. Epilepsy has a profound effect on the quality of life in this patient group. The clinician should tailor the choice of seizure prophylactic treatment to the individual patient, with the goal of limiting adverse effects, avoiding interactions and obtaining a high degree of seizure freedom. Status epilepticus is associated with inferior survival and must be treated promptly. A multidisciplinary team should treat patients with brain tumors and epilepsy.

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Section: Status Epilepticusmentioning

confidence: 99%

Seizure Management and Prophylaxis Considerations in Patients with Brain Tumors

Hauff

Storstein

2023

Curr Oncol Rep

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“…In contrast to TAE, TASE is more responsive to AED therapy and is managed by first-line AEDs like phenytoin and benzodiazepines [52]. It was also shown that TASE is as responsive to drug therapy as is status epilepticus occurring in the general population [51,63]. One recent study showed that the independent predictors of an unfavorable outcome 1 year after TASE onset were longer TASE duration, evidence of tumor progression at TASE onset, and absence of surgical treatment before onset.…”

Section: Management Of Tae and Tasementioning

confidence: 99%

Intracranial emergencies in neurosurgical oncology: pathophysiology and clinical management

Faraj

Snyder²,

McCutcheon³

2022

Emerg Cancer Care

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Intracranial tumors pose a challenge in neurosurgery, especially when patients present emergently or require emergency surgery. Tackling an acute change in the patient’s mental status is the primary reason for seeking an emergency surgery in the setting of an intracranial tumor. In addressing tumor-related complications, the aim of surgery is to relieve elevated intracranial pressure (ICP), confirm a diagnosis, improve or stabilize function, and extend the patient’s life by preventing herniation.Tumors and peritumoral edema form a space-occupying lesion that causes mass effect on nearby structures and elevates ICP. Surgical management involves (1) external ventricular drain (EVD) placement to monitor ICP, lower the volume of cerebrospinal fluid (CSF), and temporarily treat intracranial hypertension, (2) resection of the space-occupying mass responsible for the rise in ICP, and (3) in some patients, decompressive craniectomy (DC). Patients with brain tumors may also present with hydrocephalus due to the tumor’s obstructing CSF flow or disrupting CSF absorption. Tumors also cause tumor-associated epilepsy (TAE) and status epilepticus (TASE). TASE is a life-threatening condition characterized by an abnormally prolonged generalized seizure (or a chain of multiple seizures) without recovery of consciousness to baseline. Time is of the essence when managing TAE and TASE, and surgical resection of the tumor-associated epileptogenic focus can be curative. Brain tumors and their treatment can also provoke ischemic stroke, intratumoral hemorrhage, and cerebral venous sinus thrombosis depending on their location. Hemorrhagic infarction of pituitary adenomas leading to rapid expansion of the sellar region and acute pituitary gland dysfunction is known as pituitary apoplexy. Here, optimizing the patient’s hemodynamic status and treating adrenal insufficiency are crucial upon presentation. Emergency surgical resection plays an important role in saving nearby neurovascular entities when conservative treatment proves inadequate. Finally, infections of the central nervous system (CNS) occur as a result of immunologic compromise caused by the tumor itself or by its treatment.In conclusion, in severe and rapidly progressing cases in which the patient presents with altered mental status and neurologic deficits, an emergency neurosurgical procedure is indicated for removal of the cause(s) of the excess ICP, protection of brain function, and monitoring of ICP.

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“…Vascular studies help identify infarcts, a common cause of new status, both arterial or venous, and cavernomas. Whilst potentially a late disease feature [26], SE due to metastases and primary brain tumours can respond to anti-seizure therapy [27]. Contrast CT can also be used to identify intracranial metastasis, that account for 7% of SE.…”

Section: First-line Cranial Imagingmentioning

confidence: 99%

A tiered strategy for investigating status epilepticus

Craig

Mitchell

Thomas

2020

Seizure

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In status epilepticus the imperative to start anti-seizure therapy, initially subjugates the need to investigate the cause. Once treatment is initiated this balance shifts in favour of identifying: the causes and consequences of the seizure; the factors that predetermined the occurrence of status epilepticus; and finally the prognosis of this acute episode. Just as there are multiple causes of seizures and epilepsy, there are a vast number of causes of status epilepticus. We discuss the more common and the more important to identify as they may dictate a change in therapy or a certain prognosis.Acknowledging that the burden of epilepsy and status epilepticus is preferentially felt in lower and middle income countries, we have tried to rationalise the investigation of status epilepticus. Basic laboratory studies are necessary in all patients with status epilepticus as systemic complications can occur early and can involve every organ system. Aetiology is important, however the morbidity from treatment does not discriminate when treatment resistant status epilepticus is due to dissociative seizures.Seven percent of epilepsy hospitalisations are for status epilepticus and epilepsy is a prior diagnosis half the time; awareness of prior history is invaluable. EEG is critical for diagnosis in the anaesthetised patient or those in non-convulsive status epilepticus. There is poor correlation of EEG with aetiology except in rare circumstances. Currently quantitative EEG methods should best be viewed as screening tool to reduce EEG reviewing time. MRI is clearly superior for identifying cytotoxic change and the networks that are or were involved in the episode of status epilepticus. Sequential imaging changes may give an estimate of recovery but there is insufficient detail to use MRI as a prognostication tool.We suggest the following model: 1) immediate investigations; 2) investigations targeted by the clinical scenario; 3) investigations targeted following results from bloods, imaging or EEG; 4) investigations targeted for rarer causes and super-refractory status epilepticus. First-line laboratory investigationsBasic laboratory studies are necessary in all SE patients as systemic complications can occur early and can involve every organ system. Laboratory data can aid early treatment strategies [6] and tools that

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Status epilepticus secondary to glioma

Abstract: SE secondary to glioma responded well to treatment and should be treated aggressively regardless of the oncological prognosis. Seizures during tumor progression were not more treatment refractory than SE in patients with stable glioma disease.

Cited by 19 publications

References 41 publications

Seizure Management and Prophylaxis Considerations in Patients with Brain Tumors

Seizure Management and Prophylaxis Considerations in Patients with Brain Tumors

Intracranial emergencies in neurosurgical oncology: pathophysiology and clinical management

A tiered strategy for investigating status epilepticus

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