Treatment of Epilepsy Associated with Brain Tumors

Ji Hoon Phi; Chun Kee Chung

doi:10.5124/jkma.2010.53.7.603

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Phi and Chung: Treatment of Epilepsy Associated with Brain Tumors

Original Article

J Korean Med Assoc 2010;53(7):603-612.

Published online: 17 December 2010

DOI: https://doi.org/10.5124/jkma.2010.53.7.603

Treatment of Epilepsy Associated with Brain Tumors

Ji Hoon Phi, MD, Chun Kee Chung, MD

Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea

Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea

Corresponding author: Chun Kee Chung E-mail: chungc@snu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Epilepsy associated with brain tumors (EABT) is a multi-faceted disease that both oncological and epileptological concerns should be taken into consideration. Usually, it is characterized by chronic drug-resistant epilepsy with a low-grade brain tumor in the cerebrum. However, the distinction of typical EABT and simple brain tumors with short-term epilepsy is obscure. We need a working formulation based on the patient? s burden in both oncological and epileptological aspects. The diagnosis of EABT is straightforward, but the treatment should be more complex. Medical treatment with anticonvulsants aloneseems tobe anoutdated remedy for EABT because of the risk of tumor growth and malignant progression in some patients as well as the expected favorable seizure control after surgery. Surgical treatment of EABT has resulted in seizure-free state in about 80% of patients. Complete resection of the tumor is an important prognostic factor in seizure control and probably also in tumor control. Recently, many authors emphasized a lesion-directed surgery aimed at a complete tumor removal in EABT. However, in some patients, especially in patients with dual pathology, electrophysiological studies have to be thoroughly applied. For the treatment of EABT in the temporal lobe, more sophisticated surgical strategy is required. A lesionectomy saving the uninterrupted hippocampus could be applied for selected patients. Further research is strongly needed for better understanding and treatment of EABT and low-grade glioma.

Keywords: Brain tumor, Epileptogenesis, Surgery, Low-grade glioma

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Figure 1.

A diagram depicting the epileptogenesis in the presence of a brain tumor and disease progression. Dual pathology can be attributed to secondary epileptogenesis.

Figure 2.

MR images of a 36-year-old female with 8-year-history of complex partial seizures. (A)A 2cm-sized tumor (arrow) is observed in right lateral temporal lobe in a T2-weighted image. (B)In a FLAIR image, ipsilateral hippocampus (arrow) is smaller than the counterpart and its signal intensity is increased, which are typical of hippocampal sclerosis. The patient had dual pathology.

Figure 3.

Preoperative and postoperative T2-weighted MR images of a 22-year-old male with 2-year-history of complex partial seizures. (A)A 1cm-sized tumor (arrow) is observed in left amygdaloid body in a preoperative image. (B)The amygdaloid body and the tumor were completely removed via a transsylvivan approach. The uninvolved hippocampus was preserved. The intact hippocampus (arrow) is observed in a postoperative image.

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