Brain tumors and epilepsy.
Brain tumors and epilepsy.
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DOI：
10.1586/14737175.8.6.941
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发表时间：
2008-06-01
影响因子：
4.3
通讯作者：
Duffau, Hugues
中科院分区：
文献类型：
--
作者：
Brogna, Christian;Gil Robles, Santiago;Duffau, Hugues
在治疗患有脑肿瘤的患者时，必须将癫痫的教条与神经肿瘤学的观点结合起来。由于不同的癫痫发生机制，低级别和高级别肿瘤的癫痫发作频率差别很大。病理神经网络的现代理论，特别是在低级别神经胶质瘤中，可以为深入理解癫痫发作、认知障碍和可塑性的连接主义原理提供关键。结论是非肿瘤相关性癫痫患者的一般管理原则适用于神经肿瘤学。然而，由于肿瘤是复杂的演变病变，需要多学科的治疗方法（手术、放疗和化疗），因此在选择最佳抗癫痫药物时，必须全面了解每种病变的自然历史。超过三分之二的脑肿瘤和医学上难治性癫痫患者受益于（亚）全手术切除。因此，从肿瘤学和癫痫学的角度考虑，这些患者都是很好的手术候选人，以改变病变的自然历史，同时提高生活质量。然而，15%的患者术后仍有顽固性癫痫发作。此外，脑岛可能比通常认为的更频繁地参与（难治性）癫痫发作。因此，在这些患者中，可能会建议进行有创脑电图记录并最终进行第二次癫痫手术。
When treating patients harboring a brain tumor, it is mandatory to integrate the dogmas of epilepsy into a neuro-oncological viewpoint. The frequency of seizures differs widely between low- and high-grade tumors because of different mechanisms of epileptogenesis. The modern theories of pathological neural networks, especially in low-grade gliomas, can provide the key for an in-depth understanding of the principles of connectionism that underline both seizures, cognitive impairment and plasticity. It is a consuetude that principles of general management of patients with nontumor-related epilepsy are applied to neuro-oncology. Nevertheless, since tumors are complex evolving lesions requiring a multidisciplinary treatment approach (surgery, radiotherapy and chemotherapy), it is mandatory to have a comprehensive view of the natural history of each lesion when choosing the best antiepileptic drug. More than two thirds of patients with brain tumors and medically intractable epilepsy benefit from (sub)total surgical resection. Therefore, these patients are good surgical candidates both for oncological and epileptological considerations, in order to change the natural history of the lesion and to improve the quality of life at the same time. However, 15% of patients still have intractable medical seizures after surgery. Moreover, the insula may participate more often than usually considered in (intractable) seizures. Therefore, in these patients, invasive EEG recordings and eventually a second epilepsy surgery might be proposed.