Pharmacotherapy of epileptic seizures in glioma patients: who, when, why and how long?

Background: The risk for patients with primary brain tumors of experiencing an epileptic seizure at least once in the course of disease probably exceeds 50%, depending on tumor location and tumor type. Several aspects regarding the role of anticonvulsants in the treatment of brain tumor patients have remained controversial.
Patients and Methods: We reviewed the seizure history in 107 patients undergoing a surgical procedure for glioma at our institution.
Results: The overall seizure incidence was 68%. Pre-operative seizures did not predict the occurrence of post-operative seizures. After surgery, postoperative chemo- or radiotherapy and anticonvulsive therapy one third of patients was seizure-free whereas one third showed frequent seizures despite this treatment. Seizure frequency increased regardless of anticonvulsive treatment with progressive or recurrent tumor growth.
Conclusions: Based on a literature review and our institutional experience, we delineate some recommendations for the management of seizures in patients with brain tumors.