Seizures in patients with low-grade gliomas — incidence, pathogenesis, surgical management, and pharmacotherapy

  • D. Kurzwelly
  • U. Herrlinger
  • M. Simon
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 35)


Seizures complicate the clinical course of >80% of patients with low-grade gliomas. Patients with some tumor variants almost always have epilepsy. Diffuse low-grade gliomas (LGG) are believed to cause epilepsy through partial deafferentiation of nearby brain cortex (denervation hypersensitivity). Glioneural tumors may interfere with local neurotransmitter levels and are sometimes associated with structural abnormalities of the brain which may produce seizures. The severity of tumor associated epilepsy varies considerably between patients. Some cases may present with a first seizure. Others suffer from long-standing pharmacoresistant epilepsy.

Seizure control rates of >70–80% can be expected after complete tumor resections. Patients with drug-resistant epilepsy require a comprehensive preoperative epileptological work-up which may include the placement of subdural (and intraparenchymal) electrodes or intraoperative electrocorticography (ECoG) for the delineation of extratumoral seizure foci. Partial and subtotal tumor resections are helpful in selected cases, i.e. for gliomas involving the insula.

In one series, 40% of patients presented for surgery with uncontrolled seizures, i.e. medical therapy alone often fails to control tumor-related epilepsy. Use of the newer (second generation) non-enzyme inducing antiepileptic drugs (non-EIAED) is encouraged since they seem to have lesser interactions with other medications (e.g. chemotherapy). Chemotherapy and irradiation may have some minor beneficial effects on the patients’ seizure disorder.

Overall 60–70% of patients may experience recurrent epilepsy during longterm follow-up. Recurrent seizures (not infrequently heralding tumor recurrence) after surgery continue to pose significant clinical problems.


Low-grade glioma epilepsy surgery medical treatment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Acharya S, Bussel JB (2000) Hematologic toxicity of sodium valproate. J Pediatr Hematol Oncol 22: 62–65PubMedCrossRefGoogle Scholar
  2. 2.
    Ahlsén G, Gillberg IC, Lindblom R, Gillberg C (1994) Tuberous sclerosis in Western Sweden. A population study of cases with early childhood onset. Arch Neurol 51: 76–81PubMedGoogle Scholar
  3. 3.
    Anderson GD, Lin YX, Berge C, Ojemann GA (1997) Absence of bleeding complications in patients undergoing cortical surgery while receiving valproate treatment. J Neurosurg 87: 252–56PubMedCrossRefGoogle Scholar
  4. 4.
    Baker AF, Dorr RT (2001) Drug interactions with the taxanes: clinical implications. Cancer Treat Rev 27: 221–33PubMedCrossRefGoogle Scholar
  5. 5.
    Bartolomei JC, Christopher S, Vives K, Spencer DD, Piepmeier JM (1997) Low-grade gliomas of chronic epilepsy: a distinct clinical and pathological entity. J Neurooncol 34: 79–84PubMedCrossRefGoogle Scholar
  6. 6.
    Bateman DE, Hardy JA, McDermott JR, Parker DS, Edwardson JA (1988) Amino acid neurotransmitter levels in gliomas and their relationship to the incidence of epilepsy. Neurol Res 10: 112–14PubMedGoogle Scholar
  7. 7.
    Baulac M, Leppik IE (2007) Efficacy and safety of adjunctive zonisamide therapy for refractory partial seizures. Epilepsy Res 75: 75–83PubMedCrossRefGoogle Scholar
  8. 8.
    Beaumont A, Whittle IR (2000) The pathogenesis of tumour associated epilepsy. Acta Neurochir (Wien) 142: 1–15CrossRefGoogle Scholar
  9. 9.
    Ben Menachem E, Brodie MJ, Perruca E (2006) Efficacy of levetiracetam monotherapy. Randomized double-blind head-to-head comparison with carbamazepine-CR in newly diagnosed epilepsy patients with partial onset of generalized tonic-clonic seizures [abstract]. Neurology 65(5 Suppl 2): A73Google Scholar
  10. 10.
    Berger MS, Ghatan S, Haglund MM, Dobbins J, Ojemann GA (1993) Low-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg 79: 62–69PubMedCrossRefGoogle Scholar
  11. 11.
    Blümcke I, Luyken C, Urbach H, Schramm J, Wiestler OD (2004) An isomorphic subtype of long-term epilepsy-associated astrocytomas associated with benign prognosis. Acta Neuropathol 107: 381–88PubMedCrossRefGoogle Scholar
  12. 12.
    Bootsma HP, Ricker L, Diepman L, Gehring J, Hulsman J, Lambrechts D, Leenen L, Majoie M, Schellekens A, de Krom M, Aldenkamp AP (2008) Long-term effects of levetiracetam and topiramate in clinical practice: a head-to-head comparison. Seizure 17: 19–26PubMedCrossRefGoogle Scholar
  13. 13.
    Bourg V, Lebrun C, Chichmanian RM, Thomas P, Frenay M (2001) Nitroso-ureacisplatin-based chemotherapy associated with valproate: increase of haematologic toxicity. Ann Oncol 12: 217–19PubMedCrossRefGoogle Scholar
  14. 14.
    Bourgeois M, Sainte-Rose C, Cinalli G, Maixner W, Malucci C, Zerah M, Pierre-Kahn A, Renier D, Hoppe-Hirsch E, Aicardi J (1999) Epilepsy in children with shunted hydrocephalus. J Neurosurg 90: 274–81PubMedCrossRefGoogle Scholar
  15. 15.
    Bourgeois M, Di Rocco F, Roujeau T, Boddaert N, Lelouch-Tubiana A, Varlet P, Eisermann M, Piana H, Baugnon T, Puget S, Pierre-Kahn A, Zerah M, Sainte-Rose C (2008) Epilepsy and focal lesions in children. Surgical management. Neurochirurgie 54: 362–65PubMedCrossRefGoogle Scholar
  16. 16.
    Brada M, Viviers L, Abson C, Hines F, Britton J, Ashley S, Sardell S, Traish D, Gonsalves A, Wilkins P, Westbury C (2003) Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol 14: 1715–21PubMedCrossRefGoogle Scholar
  17. 17.
    Brat DJ, Scheithauer BW, Eberhart CG, Burger PC (2001) Extraventricular neurocytomas: pathologic features and clinical outcome. Am J Surg Pathol 25: 1252–60PubMedCrossRefGoogle Scholar
  18. 18.
    Brat DJ, Parisi JE, Kleinschmidt-DeMasters BK, Yachnis AT, Montine TJ, Boyer PJ, Powell SZ, Prayson RA, McLendon RE (2008) Neuropathology Committee, College of American Pathologists. Surgical neuropathology update: a review of changes introduced by the WHO classification of tumours of the central nervous system, 4th edn. Arch Pathol Lab Med 132: 993–1007PubMedGoogle Scholar
  19. 19.
    Britton JW, Cascino GD, Sharbrough FW, Kelly PJ (1994) Low-grade glial neoplasms and intractable partial epilepsy: efficacy of surgical treatment. Epilepsia 35: 1130–35PubMedCrossRefGoogle Scholar
  20. 20.
    Brown PD, Buckner JC, O’Fallon JR, Iturria NL, Brown CA, O’Neill BP, Scheithauer BW, Dinapoli RP, Arusell RM, Abrams RA, Curran WJ, Shaw EG, North Central Cancer Treatment Group, Mayo Clinic (2004) Adult patients with supratentorial pilocytic astrocytomas: a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys 58: 1153–69PubMedGoogle Scholar
  21. 21.
    Calatozzolo C, Gelati M, Ciusani E, Sciacca FL, Pollo B, Cajola L, Marras C, Silvani A, Vitellaro-Zuccarello L, Croci D, Boiardi A, Salmaggi A (2005) Expression of drug resistance proteins Pgp, MRP1, MRP3, MRP5 and GST-pi in human glioma. J Neurooncol 74: 113–21PubMedCrossRefGoogle Scholar
  22. 22.
    Cascino GD, Kelly PJ, Sharbrough FW, Hulihan JF, Hirschorn KA, Trenerry MR (1992) Long-term follow-up of stereotactic lesionectomy in partial epilepsy: predictive factors and electroencephalographic results. Epilepsia 33: 639–44PubMedCrossRefGoogle Scholar
  23. 23.
    Chalifoux R, Elisevich K (1996) Effect of ionizing radiation on partial seizures attributable to malignant cerebral tumors. Stereotact Funct Neurosurg 67: 169–82PubMedCrossRefGoogle Scholar
  24. 24.
    Chang EF, Potts MB, Keles GE, Lamborn KR, Chang SM, Barbaro NM, Berger MS (2008) Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg 108: 227–35PubMedCrossRefGoogle Scholar
  25. 25.
    Chang SM, Parney IF, McDermott M, Barker FG 2nd, Schmidt MH, Huang W, Laws ER Jr, Lillehei KO, Bernstein M, Brem H, Sloan AE, Berger M (2003) Glioma outcomes investigators. Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98: 1175–81PubMedCrossRefGoogle Scholar
  26. 26.
    Choi JY, Chang JW, Park YG, Kim TS, Lee BI, Chung SS (2004) A retrospective study of the clinical outcomes and significant variables in the surgical treatment of temporal lobe tumor associated with intractable seizures. Stereotact Funct Neurosurg 82: 35–42PubMedCrossRefGoogle Scholar
  27. 27.
    Chung S, Wang N, Hank N (2007) Comparative retention rates and long-term tolerability of new antiepileptic drugs. Seizure 16: 296–304PubMedCrossRefGoogle Scholar
  28. 28.
    Clusmann H, Kral T, Fackeldey E, Blümcke I, Helmstaedter C, von Oertzen J, Urbach H, Schramm J (2004) Lesional mesial temporal lobe epilepsy and limited resections: prognostic factors and outcome. J Neurol Neurosurg Psychiatry 75: 1589–96PubMedCrossRefGoogle Scholar
  29. 29.
    Cohen N, Strauss G, Lew R, Silver D, Recht L (1988) Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 6: 1621–24PubMedGoogle Scholar
  30. 30.
    De Santis A, Villani R, Sinisi M, Stocchetti N, Perucca E (2002) Add-on phenytoin fails to prevent early seizures after surgery for supratentorial brain tumors: a randomized controlled study. Epilepsia 43: 175–82PubMedCrossRefGoogle Scholar
  31. 31.
    Deutschman CS, Haines SJ (1985) Anticonvulsant prophylaxis in neurological surgery. Neurosurgery 17: 510–17PubMedGoogle Scholar
  32. 32.
    Duffau H, Capelle L, Denvil D, Sichez N, Gatignol P, Taillandier L, Lopes M, Mitchell MC, Roche S, Muller JC, Bitar A, Sichez JP, van Effenterre R (2003) Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. J Neurosurg 98: 764–78PubMedCrossRefGoogle Scholar
  33. 33.
    Duffau H, Capelle L (2004) Preferential brain locations of low-grade gliomas. Cancer 100: 2622–26PubMedCrossRefGoogle Scholar
  34. 34.
    Duffau H, Taillandier L, Gatignol P, Capelle L (2006) The insular lobe and brain plasticity: Lessons from tumor surgery. Clin Neurol Neurosurg 108: 543–48PubMedCrossRefGoogle Scholar
  35. 35.
    Echlin FA (1959) The supersensitivity of chronically “isolated” cerebral cortex as a mechanism in focal epilepsy. Electroencephalog Clin Neurophysiol 11: 697–732CrossRefGoogle Scholar
  36. 36.
    Engel J Jr (1989) Seizures and epilepsy. FA Davis, Philadelphia, pp 221–39Google Scholar
  37. 37.
    Eyal S, Yagen B, Sobol E, Altschuler Y, Shmuel M, Bialer M (2004) The activity of antiepileptic drugs as histone deacetylase inhibitors. Epilepsia 45: 737–44PubMedCrossRefGoogle Scholar
  38. 38.
    Fernandez C, Figarella-Branger D, Girard N, Bouvier-Labit C, Gouvernet J, Paz Paredes A, Lena G (2003) Pilocytic astrocytomas in children: prognostic factors — a retrospective study of 80 cases. Neurosurgery 53: 544–55PubMedCrossRefGoogle Scholar
  39. 39.
    Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr (2005) Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46: 470–72PubMedCrossRefGoogle Scholar
  40. 40.
    Fouladi M, Jenkins J, Burger P, Langston J, Merchant T, Heideman R, Thompson S, Sanford A, Kun L, Gajjar A (2001) Pleomorphic xanthoastrocytoma: favorable outcome after complete surgical resection. Neuro Oncol 3: 184–92PubMedCrossRefGoogle Scholar
  41. 41.
    Forsyth PA, Weaver S, Fulton D, Brasher PM, Sutherland G, Stewart D, Hagen NA, Barnes P, Cairncross JG, DeAngelis LM (2003) Prophylactic anticonvulsants in patients with brain tumour. Can J Neurol Sci 30: 106–12PubMedGoogle Scholar
  42. 42.
    Frenay MP, Fontaine D, Vandenbos F, Lebrun C (2005) First-line nitrosourea-based chemotherapy in symptomatic non-resectable supratentorial pure low-grade astrocytomas. Eur J Neurol 12: 685–90PubMedCrossRefGoogle Scholar
  43. 43.
    Fukamachi A, Koizumi H, Nukui H (1985) Immediate postoperative seizures: incidence and computed tomographic findings. Surg Neurol 24: 671–76PubMedCrossRefGoogle Scholar
  44. 44.
    Gerstner T, Teich M, Bell N, Longin E, Dempfle CE, Brand J, König S (2006) Valproate-associated coagulopathies are frequent and variable in children. Epilepsia 47: 1136–43PubMedCrossRefGoogle Scholar
  45. 45.
    Gilmore R, Morris H 3rd, Van Ness PC, Gilmore-Pollak W, Estes M (1994) Mirror focus: function of seizure frequency and influence on outcome after surgery. Epilepsia 35: 258–63PubMedCrossRefGoogle Scholar
  46. 46.
    Glantz MJ, Cole BF, Forsyth PA, Recht LD, Wen PY, Chamberlain MC, Grossman SA, Cairncross JG (2000) Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 54: 1886–93PubMedGoogle Scholar
  47. 47.
    Goldring S, Rich KM, Picker S (1986) Experience with gliomas in patients presenting with chronic seizure disorder. Clin Neurosurg 33: 15–42PubMedGoogle Scholar
  48. 48.
    Henkel A, Noachter S, Pfander M, Lüders HO (2002) The localizing value of the abdominal aura and its evolution. A study in focal epilepsies. Neurology 58: 271–76PubMedGoogle Scholar
  49. 49.
    Hildebrand J, Lecaille C, Perennes J, Delattre JY (2005) Epileptic seizures during follow-up of patients treated for primary brain tumors. Neurology 65: 212–15PubMedCrossRefGoogle Scholar
  50. 50.
    Hwang SL, Lin CL, Lee KS, Lieu AS, Kuo TH, Chang CZ, Yen CP, Lin CK, Loh JK, Huang TY, Howng SL (2004) Factors influencing seizures in adult patients with supratentorial astrocytic tumors. Acta Neurochir (Wien) 46: 589–94CrossRefGoogle Scholar
  51. 51.
    Johnston A, Smith P (2007) Sudden unexpected death in epilepsy. Expert Rev Neurother 7: 1751–61PubMedCrossRefGoogle Scholar
  52. 52.
    Jooma R, Yeh HS, Privitera MD, Gartner M (1995) Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures. J Neurosurg 83: 231–36PubMedCrossRefGoogle Scholar
  53. 53.
    Karceski S, Morrell MJ, Carpenter D (2005) Treatment of epilepsy in adults: expert opinion 2005. Epilepsy Behav 7(Suppl 1): 1–64CrossRefGoogle Scholar
  54. 54.
    Klein M, Engelberts NH, van der Ploeg HM, Kasteleijn-Nolst Trenité DG, Aaronson NK, Taphoorn MJ, Baaijen H, Vandertop WP, Muller M, Postma TJ, Heimans JJ (2003) Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54: 514–20PubMedCrossRefGoogle Scholar
  55. 55.
    Klepper J, Büsse M, Strassburg HM, Sörensen N (1998) Epilepsy in shunt-treated hydrocephalus. Dev Med Child Neurol 40: 731–36PubMedCrossRefGoogle Scholar
  56. 56.
    Komori T, Scheithauer BW, Anthony DC, Rosenblum MK, McLendon RE, Scott RM, Okazaki H, Kobayashi M (1998) Papillary glioneuronal tumour: new variant of mixed neuronal-glial neoplasm. Am J Surg Pathol 22: 1171–83PubMedCrossRefGoogle Scholar
  57. 57.
    Kothare SV, Kaleyias J (2008) Zonisamide: review of pharmacology, clinical efficacy, tolerability, and safety. Expert Opin Drug Metab Toxicol 4: 493–506PubMedCrossRefGoogle Scholar
  58. 58.
    Kvam DA, Loftus CM, Copeland B, Quest DO (1983) Seizures during the immediate postoperative period. Neurosurgery 12: 14–17PubMedCrossRefGoogle Scholar
  59. 59.
    Lang FF, Gilbert MR (2006) Diffusely infiltrative low-grade gliomas in adults. J Clin Oncol 24: 1236–45PubMedCrossRefGoogle Scholar
  60. 60.
    Lellouch-Tubiana A, Boddaert N, Bourgeois M, Fohlen M, Jouvet A, Delalande O, Seidenwurm D, Brunelle F, Sainte-Rose C (2005) Angiocentric neuroepithelial tumor (ANET): a new epilepsy-related clinicopathological entity with distinctive MRI. Brain Pathol 15: 281–86PubMedGoogle Scholar
  61. 61.
    Liigant A, Haldre S, Oun A, Linnamägi U, Saar A, Asser T, Kaasik AE (2001) Seizure disorders in patients with brain tumors. Eur Neurol 45: 46–51PubMedCrossRefGoogle Scholar
  62. 62.
    Li XN, Shu Q, Su JM, Perlaky L, Blaney SM, Lau CC (2005) Valproic acid induces growth arrest, apoptosis, and senescence in medulloblastomas by increasing histone hyperacetylation and regulating expression of p21Cip1, CDK4, and CMYC. Mol Cancer Ther 4: 1912–22PubMedCrossRefGoogle Scholar
  63. 63.
    Lombardi D, Marsh R, de Tribolet N (1997) Low-grade glioma in intractable epilepsy: lesionectomy versus epilepsy surgery. Acta Neurochir (Wien) [Suppl] 68: 70–74Google Scholar
  64. 64.
    Loscher W, Potschka H (2002) Role of multidrug transporters in pharmacoresistance to antiepileptic drugs. J Pharmacol Exp Ther 301: 7–14PubMedCrossRefGoogle Scholar
  65. 65.
    Lüders H, Acharya J, Baumgartner C, Benbadis S, Bleasel A, Burgess R, Dinner DS, Ebner A, Foldvary N, Geller E, Hamer H, Holthausen H, Kotagal P, Morris H, Meencke HJ, Noachter S, Rosenow F, Sakamoto A, Steinhoff BJ, Tuxhorn I, Wyllie E (1998) Semiological seizure classification. Epilepsia 39: 1006–13PubMedCrossRefGoogle Scholar
  66. 66.
    Lüders HO (2001) Clinical evidence for secondary epileptogenesis. Int Rev Neurobiol 45: 469–80PubMedCrossRefGoogle Scholar
  67. 67.
    Luyken C, Blümcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, Schramm J (2003) The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44: 822–30PubMedCrossRefGoogle Scholar
  68. 68.
    Luyken C, Blümcke I, Fimmers R, Urbach H, Wiestler OD, Schramm J (2004) Supratentorial gangliogliomas: histopathologic grading and tumor recurrence in 184 patients with a median follow-up of 8 years. Cancer 101: 146–55PubMedCrossRefGoogle Scholar
  69. 69.
    Majores M, von Lehe M, Fassunke J, Schramm J, Becker AJ, Simon M (2008) Tumor recurrence and malignant progression of gangliogliomas. Cancer 113: 3355–63PubMedCrossRefGoogle Scholar
  70. 70.
    Maschio M, Albani F, Baruzzi A, Zarabla A, Dinapoli L, Pace A, Pompili A, Carapella CM, Occhipinti E, Jandolo B (2006) Levetiracetam therapy in patients with brain tumour and epilepsy. J Neurooncol 80: 97–100PubMedCrossRefGoogle Scholar
  71. 71.
    Morrell F (1985) Secondary epileptogenesis in man. Arch Neurol 42: 318–35PubMedGoogle Scholar
  72. 72.
    Newton HB, Goldlust SA, Pearl D (2006) Retrospective analysis of the efficacy and tolerability of levetiracetam in brain tumor patients. J Neurooncol 78: 99–102PubMedCrossRefGoogle Scholar
  73. 73.
    Oberndorfer S, Schmal T, Lahrmann H, Urbanits S, Lindner K, Grisold W (2002) The frequency of seizures in patients with primary brain tumors or cerebral metastases. Wien Klin Wochenschr 114: 911–16PubMedGoogle Scholar
  74. 74.
    Oberndorfer S, Piribauer M, Marosi C, Lahrmann H, Hitzenberger P, Grisold W (2005) P450 enzyme inducing and non-enzyme inducing antiepileptics in glioblastoma patients treated with standard chemotherapy. J Neurooncol 72: 255–60PubMedCrossRefGoogle Scholar
  75. 75.
    O’Brien DF, Farrell M, Delanty N, Traunecker H, Perrin R, Smyth MD, Park TS (2007) Children’s Cancer and Leukaemia Group. The Children’s Cancer and Leukaemia Group guidelines for the diagnosis and management of dysembryoplastic neuroepithelial tumours. Br J Neurosurg 21: 539–49CrossRefGoogle Scholar
  76. 76.
    Otoul C, Arrigo C, Van Rijckevorsel K, French JA (2005) Meta-analysis and indirect comparisons of levetiracetam with other second-generation antiepileptic drugs in partial epilepsy. Clin Neuropharmacol 28: 72–78PubMedCrossRefGoogle Scholar
  77. 77.
    Pace A, Vidiri A, Galiè E, Carosi M, Telera S, Cianciulli AM, Canalini P, Giannarelli D, Jandolo B, Carapella CM (2003) Temozolomide chemotherapy for progressive low-grade glioma: clinical benefits and radiological response. Ann Oncol 14: 1722–26PubMedCrossRefGoogle Scholar
  78. 78.
    Packer RJ, Sutton LN, Patel KM, Duhaime AC, Schiff S, Weinstein SR, Gaillard WD, Conry JA, Schut L (1994) Seizure control following tumor surgery for childhood cortical low-grade gliomas. J Neurosurg 80: 998–1003PubMedCrossRefGoogle Scholar
  79. 79.
    Penfield W, Erickson TC, Tarlov I (1940) Relation of intracranial tumours and symptomatic epilepsy. Arch Neurol Psychiatry 44: 300–15Google Scholar
  80. 80.
    Perry JR, Sawka C (1996) Add-on gabapentin for refractory seizures in patients with brain tumours. Can J Neurol Sci 23: 128–31PubMedGoogle Scholar
  81. 81.
    Pfänder M, Arnold S, Henkel A, Weil S, Werhahn KJ, Eisensehr I, Winkler PA, Noachter S (2002) Clinical features and EEG findings differentiating mesial from neocortical temporal lobe epilepsy. Epileptic Disord 4: 189–95PubMedGoogle Scholar
  82. 82.
    Picot MC, Baldy-Moulinier M, Daurès JP, Dujols P, Crespel A (2008). The prevalence of epilepsy and pharmacoresistant epilepsy in adults: a population-based study in a Western European country. Epilepsia 49: 1230–38PubMedCrossRefGoogle Scholar
  83. 83.
    Potschka H, Baltes S, Loscher W (2004) Inhibition of multidrug transporters by verapamil or probenecid does not alter blood-brain barrier penetration of levetiracetam in rats. Epilepsy Res 58: 85–91PubMedCrossRefGoogle Scholar
  84. 84.
    Raymond AA, Halpin SF, Alsanjari N, Cook MJ, Kitchen ND, Fish DR, Stevens JM, Harding BN, Scaravilli F, Kendall B, Shorvon SD, Neville BGR (1994) Dysembryoplastic neuroepithelial tumor. Features in 16 patients. Brain 117: 461–75PubMedCrossRefGoogle Scholar
  85. 85.
    Riva M (2005) Brain tumoral epilepsy: a review. Neurol Sci 26(Suppl 1): 40–42CrossRefGoogle Scholar
  86. 86.
    Rogers LR, Morris HH, Lupica K (1993) Effect of cranial irradiation on seizure frequency in adults with low-grade astrocytoma and medically intractable epilepsy. Neurology 43: 1599–601PubMedGoogle Scholar
  87. 87.
    Rossi GF, Scerrati M, Roselli R (1985) Epileptogenic cerebral low-grade tumors: effect of interstitial stereotactic irradiation on seizures. Appl Neurophysiol 48: 127–32PubMedGoogle Scholar
  88. 88.
    Rossi GF, Pompucci A, Colicchio G, Scerrati M (1999) Factors of surgical outcome in tumoural epilepsy. Acta Neurochir (Wien) 141: 819–24CrossRefGoogle Scholar
  89. 89.
    Sartorius CJ, Berger MS (1998) Rapid termination of intraoperative stimulation-evoked seizures with application of cold Ringer’s lactate to the cortex. Technical note. J Neurosurg 88: 349–51PubMedCrossRefGoogle Scholar
  90. 90.
    Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42: 1044–56PubMedCrossRefGoogle Scholar
  91. 91.
    Schramm J, Kral T, Grunwald T, Blümcke I (2001) Surgical treatment for neocortical temporal lobe epilepsy: clinical and surgical aspects and seizure outcome. J Neurosurg 94: 33–42PubMedCrossRefGoogle Scholar
  92. 92.
    Schramm J, Kral T, Kurthen M, Blümcke I (2002) Surgery to treat focal frontal lobe epilepsy in adults. Neurosurgery 51: 644–55PubMedCrossRefGoogle Scholar
  93. 93.
    Schramm J, Luyken C, Urbach H, Fimmers R, Blümcke I (2004) Evidence for a clinically distinct new subtype of grade II astrocytomas in patients with long-term epilepsy. Neurosurgery 55: 340–48PubMedCrossRefGoogle Scholar
  94. 94.
    Schramm J, Aliashkevich AF (2007) Surgery for temporal mediobasal tumors: experience based on a series of 235 patients. Neurosurgery 60: 285–95PubMedCrossRefGoogle Scholar
  95. 95.
    Schramm J, Clusmann H. The surgery of epilepsy (2008) Neurosurgery 62(Suppl): SHC463-81Google Scholar
  96. 96.
    Sempere AP, Villaverde FJ, Martinez-Menéndez B, Cabeza C, Peña P, Tejerina JA (1992) First seizure in adults: a prospective study from the emergency department. Acta Neurol Scand 86: 134–38PubMedCrossRefGoogle Scholar
  97. 97.
    Sharma MC, Ralte AM, Gaekwad S, Santosh V, Shankar SK, Sarkar C (2004) Subependymal giant cell astrocytoma-a clinicopathological study of 23 cases with special emphasis on histogenesis. Pathol Oncol Res 10: 219–27PubMedCrossRefGoogle Scholar
  98. 98.
    Siddiqui F, Wen P, Dworetzky B, Cbello D, Bromfield E (2002) Use of levetiracetam in patients with brain tumours. Epilepsia 43(Suppl 7): 297Google Scholar
  99. 99.
    Simon M, Neuloh G, von Lehe M, Meyer B, Schramm J (2008) Insular gliomas: the case for surgical management. J Neurosurg. Epub Dec 19Google Scholar
  100. 100.
    Sirven JI, Wingerchuk DM, Drazkowski JF, Lyons MK, Zimmerman RS (2004) Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc 79: 1489–94PubMedCrossRefGoogle Scholar
  101. 101.
    Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW, Berger MS (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26: 1338–45PubMedCrossRefGoogle Scholar
  102. 102.
    Stefan H, Feuerstein TJ (2007) Novel anticonvulsant drugs. Pharmacol Ther 113: 165–83PubMedCrossRefGoogle Scholar
  103. 103.
    Stüer C, Vilz B, Majores M, Becker A, Schramm J, Simon M (2007) Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer 110: 2799–808PubMedCrossRefGoogle Scholar
  104. 104.
    Szelényi A, Joksimovic B, Seifert V (2007) Intraoperative risk of seizures associated with transient direct cortical stimulation in patients with symptomatic epilepsy. J Clin Neurophysiol 24: 39–43PubMedCrossRefGoogle Scholar
  105. 105.
    Tan B, Piwnica-Worms D, Ratner L (2000) Multidrug resistance transporters and modulation. Curr Opin Oncol 12: 450–58PubMedCrossRefGoogle Scholar
  106. 106.
    Tang R, Faussat AM, Majdak P, Perrot JY, Chaoui D, Legrand O, Marie JP (2004) Valproic acid inhibits proliferation and induces apoptosis in acute myeloid leukemia cells expressing P-gp and MRP1. Leukemia 18: 1246–51PubMedCrossRefGoogle Scholar
  107. 107.
    Taphoorn MJ (2003) Neurocognitive sequelae in the treatment of low-grade gliomas. Semin Oncol 30: 45–48PubMedCrossRefGoogle Scholar
  108. 108.
    Teo JG, Gultekin SH, Bilsky M, Gutin P, Rosenblum MK (1999) A distinctive glioneuronal tumour of the adult cerebrum with neuropil-like (including ‘rosetted’) islands: report of 4 cases.Am J Surg Pathol 23: 502–10PubMedCrossRefGoogle Scholar
  109. 109.
    Van Breemen MSM, Wilms EB, Vecht CJ (2007) Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6: 421–30PubMedCrossRefGoogle Scholar
  110. 110.
    Van Rijckevorsel K, Boon PA (2001) The ‘number needed to treat’ with levetiracetam (LEV): comparison with the other new antiepileptic drugs (AEDs). Seizure 10: 235–36PubMedCrossRefGoogle Scholar
  111. 111.
    Vecht CJ, Wagner GL, Wilms EB (2003) Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2: 404–09PubMedCrossRefGoogle Scholar
  112. 112.
    Vecht CJ, van Breemen M (2006) Optimizing therapy of seizures in patients with brain tumors. Neurology 67 (Suppl 4): 10–13Google Scholar
  113. 113.
    Villemure JG, de Tribolet N (1996) Epilepsy in patients with central nervous system tumors. Curr Opin Neurol 9: 424–28PubMedCrossRefGoogle Scholar
  114. 114.
    Wagner GL, Wilms EB, Van Donselaar CA, Vecht C (2003) Levetiracetam: preliminary experience in patients with primary brain tumours. Seizure 12: 585–86PubMedCrossRefGoogle Scholar
  115. 115.
    Wang M, Tihan T, Rojiani AM, Bodhireddy SR, Prayson RA, Iacuone JJ, Alles AJ, Donahue DJ, Hessler RB, Kim JH, Haas M, Rosenblum MK, Burger PC (2005) Monomorphous angiocentric glioma: a distinctive epileptogenic neoplasm with features of infiltrating astrocytoma and ependymoma. J Neuropathol Exp Neurol 64: 875–81PubMedCrossRefGoogle Scholar
  116. 116.
    Wen PY, Marks PW (2002) Medical management of patients with brain tumors. Curr Opin Oncol 14: 299–307PubMedCrossRefGoogle Scholar
  117. 117.
    Wick W, Menn O, Meisner C, Steinbach J, Hermisson M, Tatagiba M, Weller M (2005) Pharmacotherapy of epileptic seizures in glioma patients: who, when, why and how long? Onkologie 28: 391–96PubMedCrossRefGoogle Scholar
  118. 118.
    Wolf HK, Roos D, Blumcke I, Pietsch T, Wiestler OD (1996) Perilesional neurochemical changes in focal epilepsies. Acta Neuropathol 91: 376–84PubMedCrossRefGoogle Scholar
  119. 119.
    Yasargil G (1996) Microneurosurgery Vol IVB: Limbic and paralimbic tumors. Thieme Medical Publishers Inc, New York, pp 252–90Google Scholar
  120. 120.
    Zaatreh MM, Spencer DD, Thompson JL, Blumenfeld H, Novotny EJ, Mattson RH, Spencer SS (2002) Frontal lobe tumoral epilepsy: clinical, neurophysiologic features and predictors of surgical outcome. Epilepsia 43: 727–33PubMedCrossRefGoogle Scholar
  121. 121.
    Zaatreh MM, Firlik KS, Spencer DD, Spencer SS (2003) Temporal lobe tumoral epilepsy: characteristics and predictors of surgical outcome. Neurology 61: 636–41PubMedGoogle Scholar
  122. 122.
    Zentner J, Hufnagel A, Wolf HK, Ostertun B, Behrens E, Campos MG, Elger CE, Wiestler OD, Schramm J (1997) Surgical treatment of neoplasms associated with medically intractable epilepsy. Neurosurgery 41: 378–87PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2010

Authors and Affiliations

  • D. Kurzwelly
    • 1
  • U. Herrlinger
    • 1
  • M. Simon
    • 2
  1. 1.Schwerpunkt Klinische Neuroonkologie, Neurologische KlinikUniversitätskliniken BonnBonnGermany
  2. 2.Neurochirurgische KlinikUniversitätskliniken BonnBonnGermany

Personalised recommendations