Abstract：
Brain Tumour Related Epilepsy (BTRE) has a significant impact on Quality of Life with implications for driving, employment, and social activities. Management of BTRE is complex due to the higher incidence of drug resistance and the potential for interaction between anti-cancer therapy and anti-seizure medications (ASMs). Neurologists, neurosurgeons, oncologists, palliative care physicians and clinical nurse specialists treating these patients would benefit from up-to-date clinical guidelines. We aim to review the current literature and to outline specific recommendations for the optimal treatment of BTRE, encompassing both Primary Brain Tumours (PBT) and Brain Metastases (BM). A comprehensive search of the literature since 1995 on BTRE was carried out in PubMed, MEDLINE and EMCARE. A broad search strategy was used, and the evidence evaluated and graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Seizure frequency varies between 10 and 40% in patients with Brain Metastases (BM) and from 30% (high-grade gliomas) to 90% (low-grade gliomas) in patients with PBT. In patients with BM, risk factors include number of BM and melanoma histology. In patients with PBT, BTRE is more common in patients with lower grade histology, frontal and temporal tumours, presence of an IDH mutation and cortical infiltration. All patients with BTRE should be treated with ASMs. Non-enzyme inducing ASMs are recommended as first line treatment for BTRE, but up to 50% of patients with BTRE due to PBT remain resistant. There is no proven benefit for the use of prophylactic ASMs, although there are no randomised trials testing newer agents. Surgical and oncological treatments i.e. radiotherapy and chemotherapy improve BTRE. Vagus Nerve Stimulation has been used with partial success. The review highlights the relative dearth of high-quality evidence for the management of BTRE and provides a framework for further studies aiming to improve seizure control, quality of life, and indications for ASMs.KEY POINTSOffer levetiracetam or lamotrigine to all patients with primary or metastatic brain tumours who have seizure(s), irrespective of whether these are partial or generalised.ASM withdrawal for patients in remission is not recommended due to high rates of seizure recurrence.ASM prophylaxis is not generally recommended in the management of seizure-naïve patients.Both levetiracetam and lamotrigine are safe in pregnancy and breastfeeding.
摘要：
脑肿瘤相关性癫痫（BTRE）对生活质量有重大影响，对驾驶，employment,和社会活动。BTRE的管理是复杂的，因为耐药性的发生率较高，并且抗癌治疗和抗癫痫药物（ASM）之间存在潜在的相互作用。神经学家,神经外科医生,肿瘤学家,治疗这些患者的姑息治疗医师和临床护理专家将受益于最新的临床指南.我们的目标是回顾目前的文献，并概述BTRE的最佳治疗的具体建议，包括原发性脑肿瘤（PBT）和脑转移（BM）。自2000年以来，在PubMed上对BTRE的文献进行了全面搜索，MEDLINE和EMCARE.使用了广泛的搜索策略，根据牛津循证医学中心的证据水平对证据进行评估和分级。脑转移（BM）患者的癫痫发作频率在10％至40％之间变化，而PBT患者的癫痫发作频率在30％（高级别神经胶质瘤）至90％（低级别神经胶质瘤）之间变化。在BM患者中，危险因素包括BM数量和黑色素瘤组织学。在PBT患者中，BTRE在组织学分级较低的患者中更常见，额叶和颞叶肿瘤，存在IDH突变和皮质浸润。所有BTRE患者均应接受ASM治疗。非酶诱导ASM被推荐为BTRE的一线治疗。但高达50％的BTRE患者由于PBT仍然耐药。使用预防性ASM没有证实的益处，尽管没有随机试验测试较新的药物。手术和肿瘤治疗，即放疗和化疗改善BTRE。迷走神经刺激已部分成功使用。该审查强调了BTRE管理的高质量证据的相对缺乏，并为旨在改善癫痫发作控制的进一步研究提供了框架，生活质量,和ASM的适应症。KEYPOINTSOffer左乙拉西坦或拉莫三嗪用于所有患有原发性或转移性脑肿瘤的患者，不管这些是局部的还是广义的。由于癫痫发作复发率高，因此不建议缓解患者停用ASM。ASM预防通常不推荐用于治疗未发作的患者。左乙拉西坦和拉莫三嗪在怀孕和母乳喂养中都是安全的。
