WHAT IS a Seizures
Seizures occurring in a patient with cancer can be caused by the tumor
itself, by metabolic disturbances, by radiation injury, by cerebral
infarctions, by chemotherapy-related encephalopathies, or by CNS
Metastatic disease to the CNS is the most common cause
of seizures in patients with cancer. However, seizures occur more
frequently in primary brain tumors than in metastatic brain lesions.
Seizures are a presenting symptom of CNS metastasis in 6–29% of
What is symptoms of Seizures
Approximately 10% of patients with CNS metastasis eventually
develop seizures. Tumors that affect the frontal, temporal, and parietal
lobes are more commonly associated with seizures than are occipital
lesions. Both early and late seizures are uncommon in patients with
posterior fossa and sellar lesions.
Seizures are common in patients with
CNS metastases from melanoma and low-grade primary brain tumors.
Very rarely, cytotoxic drugs such as etoposide, busulfan, ifosfamide,
and chlorambucil cause seizures.
Another cause of seizures related to
drug therapy is reversible posterior leukoencephalopathy syndrome
(RPLS). Chemotherapy, targeted therapy, and immunotherapies have
been associated with the development of RPLS.
How to diagnosis of Seizures
RPLS occurs in patients
undergoing allogeneic bone marrow or solid-organ transplantation.
RPLS is characterized by headache, altered consciousness, generalized
seizures, visual disturbances, hypertension, and symmetric posterior
cerebral white matter vasogenic edema on CT/MRI. Seizures may
begin focally but are typically generalized.
How to Treatment of Seizures
Patients in whom seizures due to CNS metastases have been
demonstrated should receive anticonvulsive treatment with phe-
nytoin or levetiracetam. If this is not effective, valproic acid
can be added.
Prophylactic anticonvulsant therapy is not recom-
mended. In postcraniotomy patients, prophylactic antiepileptic
drugs should be withdrawn during the first week after surgery.
Most antiseizure medications including phenytoin induce cyto-
chrome P450 (CYP450), which alters the metabolism of many
antitumor agents, including irinotecan, taxanes, and etoposide as
well as molecular targeted agents, including imatinib, gefitinib,
erlotinib, tipifarnib, sorafenib, sunitinib, temsirolimus, everolimus,
and vemurafenib. Levetiracetam and topiramate are anticonvul-
sant agents not metabolized by the hepatic CYP450 system and do
not alter the metabolism of antitumor agents. They have become
the preferred drugs.
Surgical resection and other antitumor treat-
ments such as radiotherapy and chemotherapy may improve
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