Epilepsy and Brain Tumors (eBook)

Marta Maschio, Herbert B. Newton (Herausgeber)

eBook Download: PDF | EPUB

2015 | 1. Auflage
292 Seiten
Elsevier Science (Verlag)
978-0-12-417126-8 (ISBN)

Infos

Patients with brain tumor-related epilepsy (BTRE) suffer from two serious pathologies simultaneously - a brain tumor and a secondary form of epilepsy. Although there has been remarkable progress in BTRE research in recent years, it remains an on-going challenge for clinicians and continues to stimulate much debate in the scientific community. This volume is the first to be completely dedicated to BTRE, and in doing so it explores issues faced by the health care team as well as some of the novel and promising directions that future research may take. Epilepsy and Brain Tumors is not only a complete reference on BTRE but also a practical guide based on clinical experiences, with a comprehensive collection of presentations from international experts who share some of the latest discoveries and their approaches to tackling a wide range of difficult and complex issues. - Includes coverage of epidemiology, pathology and treatment of both primary and metastatic brain tumors - Offers additional insight into supportive care, incidence in children, focal epileptogenesis, clinical evaluation, antiepileptic drugs, surgical treatment, cognitive rehabilitation, and more - Chapters authored and edited by leaders in the field around the globe - the broadest, most expert coverage available

Inhalt

Front Cover 1
Epilepsy and Brain Tumors 4
Copyright 5
Dedication 6
Contents 8
Foreword 12
Preface 14
Contributors 16
Chapter 1: Brain Tumor-Related Epilepsy: Introduction and Overview 18
Introduction 18
Epilepsy: Definition, Incidence, Social Context and Treatment Options 19
Epilepsy in the Context of BTs: Epidemiology and Incidence 20
Detection, Classification, and Documentation of Seizures 21
The Unique Role of Epileptogenesis and Drug Resistance in BTRE 21
Pharmacoresistance 22
QoL in BTRE Patients 22
Impact of AEDs in BTRE Patients 23
Neurocognitive Evaluation and Possible Rehabilitative Programs 24
Health Economics and BTRE 24
References 25
Chapter 2: Overview of Epidemiology, Pathology, and Treatment of Primary Brain Tumors 28
Epidemiology of PBT 28
Pathology of Selected PBT 31
Diffuse Astrocytomas 32
Localized Astrocytomas 33
Oligodendrogliomas and Oligoastrocytomas 34
Medulloblastoma and Other Embryonal Tumors 34
Meningioma and Other Tumors of the Meninges 35
Primary Central Nervous System Lymphoma 37
Surgical Therapy of PBT 37
Radiation Therapy of PBT 38
Chemotherapy of PBT 38
Molecular or ``Targeted´´ Treatment 41
References 42
Chapter 3: Overview of Epidemiology, Pathology, and Treatment of Metastatic Brain Tumors 46
Epidemiology of MBTs 46
Pathology of MBTs 48
Surgical Therapy of MBTs 49
Radiation Therapy of MBTs 52
Chemotherapy of MBTs 54
Acknowledgments 56
References 56
Chapter 4: Supportive Care of Brain Tumor Patients 62
Introduction 62
Seizures and Anticonvulsant Therapy 63
Corticosteroids 65
Gastric Acid Inhibitors 67
Thromboembolic Complications and Anticoagulation 67
Dysphagia and Swallowing Disorders 68
Psychiatric Issues 69
Pain Control Issues 73
Palliative Care 74
Ethical Issues 76
Conclusion 78
References 78
Chapter 5: Brain-Tumor-Related Epilepsy in Children 82
The Pediatric Perspective 82
Epilepsy-Associated Brain Tumors 82
Pathophysiology 84
Epidemiology 86
Brain Tumors 86
Seizures and Epilepsy 86
Presentation 87
Brain Tumors 87
Seizures and Epilepsy 87
General Principles of Management 91
History and Physical Exam 91
Diagnostic Evaluation 92
Scalp EEG 92
Intracranial EEG 94
MRI 94
Other Imaging Studies 95
Magnetic and Electrical Source Localization 96
Neuropsychological Assessment and Other Studies Used to Localize Eloquent Brain 96
Genetics 96
Tissue Diagnosis and Molecular Tumor Markers 97
Medical Management 97
Anticipatory Guidance 97
Maintenance Antiseizure Drugs 97
Rescue Antiseizure Drugs 100
Role of Antiseizure Drugs in Children Without a History of Seizures 101
Chemotherapy, Biologic Agents, and Steroids 102
Dietary Considerations and Alternative Therapies 102
Surgical Management 102
Goals and Approaches 102
Timing of Surgical Resection 103
Lesionectomy (Tumorectomy) Versus Lesionectomy ``Plus´´ 104
Palliative Strategies 105
Outcome 105
Future Directions 106
References 107
Chapter 6: Mechanisms of Focal Epileptogenesis 118
Time Course and Specificity of Acquired Epileptogenesis 119
References 123
Chapter 7: Pathophysiology of Brain Tumor-Related Epilepsy 128
Introduction 128
Epidemiology of BTRE 128
Pathophysiology of BTRE 129
Treatment of BTRE 131
References 134
Chapter 8: The Neurophysiology of Central Nervous System Tumors 136
Introduction 136
EEG Modalities and Applications 137
EEG Background Changes 138
Epileptiform Activity 139
Meningiomas 141
Generation of Abnormal Cerebral Activity 148
References 148
Chapter 9: Surgical Treatment for Epilepsy 150
Introduction 150
Evaluation and Selection of the Surgical Candidate 150
Resection Procedures 151
Temporal Lobectomy 151
Common Complications 151
Extra-temporal Cortical Resections 151
Hemispherectomy 152
Nonresective Techniques 152
Disconnection Surgeries 153
Corpus Callosotomy 153
Multiple Subpial Transections 154
Vagal Nerve Stimulation 154
Deep Brain Stimulation 155
Responsive Neurostimulation 155
References 156
Chapter 10: Clinical Evaluation of Epilepsy in the Brain-Tumor Patient 160
Differential Diagnosis 162
Clinical History and Physical Examination 166
Neuroimaging Evaluation 167
Clinical and Electrophysiological Work-Up 170
Effects of Oncological Therapy on Brain Tumor-Related Epilepsy 172
Acknowledgments 174
References 174
Chapter 11: Antiepileptic Drugs: 176
Carbamazepine 176
Ethosuximide 178
Phenobarbital 180
Phenytoin 182
Primidone 183
Alproate 184
References 185
Chapter 12: Antiepileptic Drugs: Second and Third Generation 188
Introduction 188
Clobazam 188
Eslicarbazepine Acetate 190
Ezogabine/Retigabine 194
Felbamate 194
Gabapentin 195
Lacosamide 196
Lamotrigine 197
Levetiracetam 198
Oxcarbazepine 200
Perampanel 201
Pregabalin 201
Rufinamide 202
Tiagabine Hydrochloride 203
Topiramate 204
Vigabatrin 205
Zonisamide 206
References 207
Chapter 13: Antiepileptic Drugs and Brain Tumor Patients 212
Introduction 212
Pathophysiology 212
Type of Seizure 213
Treatment of Seizures 213
First-Generation AEDs 213
Newer AEDs 215
Levetiracetam 215
Oxcarbazepine 217
Lacosamide 218
Pregabalin 219
Topiramate 220
Zonisamide 220
Lamotrigine 221
Conclusion 221
References 221
Chapter 14: Clinical Approach to Brain Tumor-Related Epilepsy 224
Seizure Prophylaxis in Patients with BTRE 224
Is There a Best Practice for Seizure Treatment? 228
Introduction 228
Drug Resistance and Epileptogenicity 228
Use of Systemic Treatment for Seizure Control 229
Use of AEDs as Antineoplastic Treatment 230
Efficacy of AEDs on BTRE: An Overview 231
Adverse Events Specific to BTRE Patients 231
Potential Interactions with Systemic Treatments 232
Impact of AED Therapies on Cognition 232
Impact of AED Therapies on QoL 233
How to Choose an AED? 233
Is It Possible to Stop an AED in BTRE, and When? 234
Clinical Approach to BTRE 234
Driving and BTRE 234
References 235
Chapter 15: Neuropsychology of BTRE 242
Introduction 242
Overview of Neurocognitive Impairment in BT, Epilepsy, and BTRE 243
Neurocognitive Impairment in BT 243
Neurocognitive Impairment in Epilepsy 245
Neurocognitive Impairment in BTRE 246
Specific Cognitive Deficits in BT, Epilepsy, and BTRE 246
Specific Cognitive Deficits in BT 246
Specific Cognitive Deficits in Epilepsy 246
Specific Cognitive Deficits in BTRE 247
Overview of Neuropsychological Assessment Techniques for BT, Epilepsy, and BTRE 247
Neuropsychological Assessment Techniques for BT 247
Neuropsychological Assessment Techniques for Epilepsy 248
Neuropsychological Assessment Techniques for BTRE 249
Psychological Issues in BT, Epilepsy, and BTRE 249
Psychological Issues in BT 249
Psychological Issues in Epilepsy 250
Psychological Issues in BTRE 251
Sexual Disturbances in Patients with BT, Epilepsy and BTRE 251
Sexual Disturbances in Patients with BT 251
Sexual Disturbances in Patients with Epilepsy 252
Sexual Disturbances in Patients with BTRE 252
QoL Assessment and Monitoring in BT, Epilepsy and BTRE 252
QoL Assessment and Monitoring in BT 252
QoL Assessment and Monitoring in Epilepsy 253
QoL Assessment and Monitoring in BTRE 254
Conclusions 254
References 254
Chapter 16: Cognitive Rehabilitation in Patients with BTRE 260
Introduction 260
Goals of Cognitive Rehabilitation 261
Treatment Modalities in BT 262
Treatment Modalities in Epilepsy 263
Treatment Modalities in BTRE 264
Pharmacological Approaches for Treatment of Cognitive Deficits 264
Caregivers Issues 265
Implications for Future Research in BTRE 266
References 272
Chapter 17: Social Cost of Brain Tumor-Related Epilepsy 274
Introduction 274
Health Economic Reporting: Terminology and Aims 275
Health Economics: Funding Priorities 277
Health Technology Assessment 279
BTRE: Economic Burden Within the Context of Neurological Disease 279
Epilepsy 279
Brain Tumor 282
Conclusion 283
References 284
Chapter Appendix: The Prospects of Brain Research within Horizon 2020: Responding Efficiently to Europe’s Societal Needs ... 286
Summary 286
Index 288

Textauszug

Chapter 2

Overview of Epidemiology, Pathology, and Treatment of Primary Brain Tumors

Herbert B. Newton, MD, FAAN1,2,*; Jose J. Otero, MD, PhD3    1 Department of Neurology, Dardinger Neuro-Oncology Center, Division of Neuro-Oncology, Wexner Medical Center at The Ohio State University and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
2 Department of Neurosurgery, Dardinger Neuro-Oncology Center, Division of Neuro-Oncology, Wexner Medical Center at The Ohio State University and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
3 Department of Pathology, Wexner Medical Center at The Ohio State University and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
* Corresponding author: [e-mail]

Abstract

Primary brain tumors (PBT) are a pathologically diverse group of neoplasms that remain refractory to treatment. Gliomas are neoplasms of neuroepithelial origin that comprise the largest subgroup and most commonly diagnosed form of PBT. Gliomas usually demonstrate diffuse and infiltrative growth, especially high-grade varieties such as glioblastoma multiforme, anaplastic astrocytoma, and tumors of oligodendroglial origin. Surgical resection is the initial form of therapy for most patients with a PBT. A complete resection should be attempted for all low-grade tumors. For accessible high-grade lesions, gross-total resection of all enhancing tumor and regionally infiltrated brain should be considered. External beam fractionated irradiation should be administered to all patients with high-grade gliomas, and to selected patients with inaccessible or progressive low-grade PBT, especially if symptomatic or older than age 40. The standard regimen consists of 5000-6000 cGy administered in 180-200 cGy daily fractions over 5-7 weeks. Chemotherapy should be considered as adjunctive treatment for all malignant PBT and for selected low-grade gliomas. Temozolomide is an alkylating agent with a broad range of activity, which is often used in combination with irradiation, as well as in the adjuvant setting, for high-grade astrocytomas. Bevacizumab is a monoclonal antibody designed to target vascular endothelial growth factor, which has been shown to have activity against recurrent high-grade gliomas. Molecular therapeutic approaches are under development and have entered clinical trials.

Keywords

Primary brain tumor

Glioma

GBM

Epidemiology

Pathology

Treatment

Surgery

Radiotherapy

Chemotherapy

Chapter Contents

Epidemiology of PBT   11

Pathology of Selected PBT   14

Surgical Therapy of PBT   20

Radiation Therapy of PBT   21

Chemotherapy of PBT   21

Molecular or “Targeted” Treatment   24

Acknowledgments   25

References   25

Acknowledgments

The authors would like to thank Nicole Ghaffari and Shawna Huckell for research assistance. Dr. Newton was supported in part by National Cancer Institute grant CA 16058 and the Dardinger Neuro-Oncology Center Endowment Fund.

In this chapter, we will provide an overview of the epidemiology, classification, pathology, and treatment of common primary brain tumors (PBT). PBT remain a significant health problem in the United States and worldwide. Overall, they account for some of the most malignant tumors known to affect human beings and are often refractory to all modalities of treatment. PBT will be diagnosed in approximately 30,000-35,000 patients in the United States this year and are associated with significant morbidity and mortality.1–7 Of the estimated 14 patients per 100,000 population that will develop a PBT this year, 6-8 per 100,000 will have a high-grade neoplasm, usually some form of glioma such as glioblastoma multiforme (GBM) or anaplastic astrocytoma (AA).

Epidemiology of PBT

As mentioned above, approximately 14 per 100,000 people in the United States will be diagnosed with a PBT each year, and the majority of those will have a high-grade neoplasm (typically AA or GBM).2–7 Contemporary epidemiological studies suggest an increasing incidence rate for the development of PBT in children less than 14 years of age and in patients 70 years or older.8 For people in the 15- to 44-year-old age group, the overall incidence rates have remained fairly stable in recent years. The cause of the increased incidence of PBT in some age groups remains unclear, but may be due to improvements in diagnostic neuro-imaging such as magnetic resonance imaging (MRI), greater availability of specially qualified neurosurgeons and neuropathologists, improved access to medical care for children and elderly patients, and more aggressive approaches to health care for elderly patients.5,8 In other words, the increase in PBT incidence may be more apparent than real due to ascertainment bias.

The prognosis and survival of patients with PBT remains poor.1–7 Although uncommon neoplasms, they rank among the top 10 causes of cancer-related deaths in the United States and account for a disproportionate 2.4% of all yearly cancer-related deaths.9 The median survival for a patient with GBM is approximately 12-16 months, a figure that hasn’t improved substantially over the past 30 years. For patients with a low-grade astrocytoma or oligodendroglioma, the median survival is still significantly curtailed and is about 6-10 years. For PBT patients in the United States as a whole, across all age groups and tumor types, the 5-year survival rate is 20%.3 If a patient with a PBT survives for an initial 2 years, the probability of surviving another 3 years is 76.2%. In general, for any given tumor type, survival is better for younger patients than for older patients. The only exception to this generalization is for children with medulloblastoma and embryonal tumors, in which patients under 3 years of age have poorer survival rates than children between 3 and 14 years of age.10 The 5-year survival rate for all children less than 14 years of age with a malignant PBT is 72%.

The median age at diagnosis for PBT is between 54 and 58 years.1–7 Among different histological varieties of PBT, there is significant variability in the age of onset. A small secondary peak is also present in the pediatric age group, in children between the ages of 4 and 9. Overall, PBT are more common in males than females, with the exception of meningiomas, which are almost twice as common in females. Tumors of the sellar region, and of the cranial and spinal nerves, are almost equally represented among males and females. In the United States, gliomas are more commonly diagnosed in whites than blacks, while the incidence of meningiomas is relatively equal between the two groups.

Numerous epidemiological studies have been performed in an attempt to define risk factors involved in the development of brain tumors (see Table 2.1).2–7 The vast majority of these potential risk factors have not been associated with any significant predisposition to brain tumors. One risk factor that has proven to be important is the presence of a hereditary syndrome with a genetic predisposition for developing tumors, some of which can affect the nervous system.4,5,11 Several hereditary syndromes are associated with PBT, including tuberous sclerosis, neurofibromatosis types 1 and 2, nevoid basal cell carcinoma syndrome, Li-Fraumeni syndrome, and Turcot’s syndrome. However, it is estimated that hereditary genetic predisposition may be involved in only 2-8% of all cases of PBT. Familial aggregation of brain tumors has also been studied, with conflicting results.5,11 The relative risk for developing a tumor among family members of a patient with a PBT is quite variable, ranging from 1 to 10. One study that performed a segregation analysis of families of more than 600 adult glioma patients showed that a polygenic model most accurately explained the inheritance pattern.12 A similar analysis of 2141 first-degree relatives of 297 glioma families did not reject a multifactorial model, but concluded that an autosomal recessive model fit the inheritance pattern more accurately.13 Critics of these studies suggest that the common exposure of a family to a similar pattern of environmental agents could lead to a similar clustering of tumors. Other investigators have focused on genetic polymorphisms that might influence genetic and environmental factors to increase the risk for a brain tumor.4,5 Alterations in genes involved in oxidative metabolism, detoxification of carcinogens, DNA stability and repair, and immune responses might confer a genetic predisposition to tumors. For example, Elexpuru-Camiruaga and colleagues demonstrated that cytochrome P-4502D6 and glutathione transferase theta were associated with an increased risk for brain...

Produkt-Details

• Erscheint lt. Verlag: 6.3.2015
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Themenwelt: Naturwissenschaften ► Biologie ► Humanbiologie
• Themenwelt: Naturwissenschaften ► Biologie ► Zoologie
• ISBN-10: 0-12-417126-5 / 0124171265
• ISBN-13: 978-0-12-417126-8 / 9780124171268