Treatment of epilepsy associated with primary and metastatic brain tumors

Headache, which is often present in patients with epilepsy, can occur outside of epileptic seizures as well as have a temporary connection with them – occur immediately before, during or after an attack. Clinical types of headache in epilepsy are considered in the International Classification of Headache, but not in the classification of epileptic seizures and types of epilepsy. Meanwhile, the presence of concomitant headache and its clinical phenotype should be taken into account when choosing treatment tactics in patients with epilepsy. The article presents data on the prevalence of different types of headache in patients with epilepsy and a modern classification of cephalalgia depending on the temporal relationship with an epileptic attack. Diagnostic criteria for four clinical variants of cephalgia are given: interictal, preictal, ictal and postictal. The comorbid relationship between epilepsy and migraine is considered in more detail, including the pathophysiological mechanisms underlying the combination of these paroxysmal conditions.

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Headache and epilepsy: prevalence and clinical variants

Осипова

Артеменко

Shmidt

et al. 2023

RJTAO

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Perampanel in adjunctive therapy of patients with brain tumor-related epilepsy: real-world data

Samsonova¹,

Жидкова

2023

Èpilepsiâ paroksizmalʹnye sostoâ.

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Background. Brain tumor-related epilepsy (BTRE) is an important and insufficiently studied interdisciplinary problem. In a significant part of brain tumor patients, the disease onsets with epileptic seizures. The course of tumor-associated epilepsy is often pharmacoresistant and requires rational polytherapy. To date, there are no uniform recommendations on the choice of an antiepileptic drug (AED) for the initial therapy of BTRE.Objective: retrospective analysis of the efficacy/tolerability of adjunctive therapy with perampanel in relation to epileptic seizures in patients with epilepsy associated with glial brain tumors and metastases.Material and methods. The analysis included 51 patients with glial tumors and brain metastases who were prescribed perampanel as part of adjunctive therapy. Its effectiveness against focal seizures (FS) and bilateral tonic-clonic seizures (BTCS) was evaluated at follow-up periods of >1≥3≥6 months. A decrease in the frequency of seizures by 50% or more (responders) or by 100% (seizure freedom) was analyzed. An analysis of the influence of intervening factors in a multifactorial model, an assessment of the effectiveness of perampanel as a whole and a stratified assessment of intervening factors were carried out. The frequency and profile of adverse events (AEs) were also evaluated, including their possible association with the use of other AED.Results. In the multifactorial model, independent predictors of the clinical effect were the onset of the disease in the form of FS at >1≥3≥6 months follow-up. None of AEDs used in the first line of therapy demonstrated an impact on the clinical effect. There were no predictors of clinical effect in patients with BTCS during the entire follow-up period. Out of 51 patients, 48 (94.1%) were responders, and in 36 of them (70.6%) the seizure freedom was registered. Among patients with FS, the proportion of responders was 83.3–90.9% at different follow-up periods, including 31.2–50.0% who showed seizure freedom. Among patients with BTCS, 86.7–92.3% became responders, including 56.1–88.5% who achieved seizure freedom. AEs were noted in 7 (13.7%) patients, the most common was aggression – 4 patients (7.8%). There were no cases required reduction the dose or discontinuation the treatment with perampanel due to AEs. In most patients at >1≥3≥6 months follow-up, the median was 6 mg/day.Conclusion. The study performed in real-world practice confirmed the high efficiency and safety of perampanel in the adjunctive therapy of epileptic seizures associated with glial brain tumors and metastases, which together with the low potential of drug interactions allow us recommend the drug to this contingent of patients.

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Treatment of epilepsy associated with primary and metastatic brain tumors

Cited by 2 publications

References 75 publications

Headache and epilepsy: prevalence and clinical variants

Headache and epilepsy: prevalence and clinical variants

Perampanel in adjunctive therapy of patients with brain tumor-related epilepsy: real-world data

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