TY - JOUR
T1 - Epilepsy treatment in neuro-oncology
T2 - A rationale for drug choice in common clinical scenarios
AU - Sánchez-Villalobos, José Manuel
AU - Aledo-Serrano, Ángel
AU - Villegas-Martínez, Irene
AU - Shaikh, Mohd Farooq
AU - Alcaraz, Miguel
N1 - Publisher Copyright:
Copyright © 2022 Sánchez-Villalobos, Aledo-Serrano, Villegas-Martínez, Shaikh and Alcaraz.
PY - 2022
Y1 - 2022
N2 - Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.
AB - Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.
KW - antiseizure medication
KW - brain tumor
KW - glial tumor
KW - precision medicine
KW - seizure
KW - sodium channel blockers
UR - http://www.scopus.com/inward/record.url?scp=85140431759&partnerID=8YFLogxK
U2 - 10.3389/fphar.2022.991244
DO - 10.3389/fphar.2022.991244
M3 - Review Article
C2 - 36278161
AN - SCOPUS:85140431759
SN - 1663-9812
VL - 13
JO - Frontiers in Pharmacology
JF - Frontiers in Pharmacology
M1 - 991244
ER -