Management of brain tumor-related epilepsy: case report

Abstract

Background: Patients with brain tumor related epilepsy present a complex therapeutic profile and require a unique and multidisciplinary approach. Difficulty in managing epilepsy in patients with brain tumors stems from an overall resistance to medical therapy, frequent interactions between antiepileptic drugs and chemotherapeutic agents, and potential adverse effects of both medical and surgical treatment. Moreover, seizures significantly impact the quality of life, and continued seizures are associated with a poorer outcome. Material and methods: We present the case of a young adult patient with a brain tumor-related epilepsy. Results: A 38-year-old woman was admitted to our hospital with focal motor seizures, with impaired awareness, evolving into bilateral tonicclonic. Her video-electroencephalogram monitoring revealed left temporo-frontal epileptiform discharges, frequently bilateral in wakefulness and sleepiness. Simple and contrasted magnetic resonance of the brain showed a lesion in the left temporal lobe. Patient began taking carbamazepine and levetiracetam, her seizures were partially controlled. A surgical resection was performed, and pathological analysis revealed anaplastic astrocytoma. Post-resection she has had a significant reduction in her seizures, and she is still taking antiepileptic drugs. Conclusions: Patients with refractory epilepsy should be evaluated for potential epilepsy surgery. It is important to identify these patients early to limit the potential morbidity and mortality and to improve their quality of life.