From the Guidelines
A female patient with brain cancer and a seizure disorder typically presents with several key exam findings, including focal deficits, cognitive impairment, and seizure-related symptoms, and should be managed with anti-seizure medications such as levetiracetam or lamotrigine, as recommended by recent guidelines 1. The patient's neurological examination may reveal focal deficits corresponding to the tumor location, such as:
- Weakness
- Sensory changes
- Visual field defects
- Language difficulties Cognitive assessment might show:
- Memory impairment
- Confusion
- Personality changes Fundoscopic examination could demonstrate papilledema if intracranial pressure is elevated. Seizure-related findings might include:
- Post-ictal confusion
- Tongue biting
- Urinary incontinence
- Muscle soreness The patient may also exhibit:
- Headaches (especially morning headaches)
- Nausea
- Vomiting
- Gait disturbances Anti-seizure medications like levetiracetam (500-1500 mg twice daily) or lamotrigine (25-200 mg twice daily) are commonly used to control seizures in these patients, as they have been shown to be effective and well-tolerated 1. Dexamethasone (4-16 mg daily in divided doses) is often prescribed to reduce peritumoral edema, and regular monitoring of medication levels, complete blood counts, and liver function tests is essential due to potential side effects. The specific exam findings vary based on tumor type, location, size, and seizure characteristics, with temporal and frontal lobe tumors being particularly epileptogenic due to their involvement in neural circuitry that regulates electrical activity in the brain, as noted in recent guidelines 1.
From the Research
Exam Findings in Female Patients with Brain Cancer and Seizure Disorder
The typical exam findings in a female patient with brain cancer and a seizure disorder may include:
- Seizures, which can be simple partial, complex partial, or generalized tonic-clonic 2
- Altered mental status, such as confusion or disorientation
- Focal neurological deficits, such as weakness or numbness in a specific area of the body
- Signs of increased intracranial pressure, such as headache or papilledema
Seizure Frequency and Control
Studies have shown that:
- Seizure frequency can be reduced with the use of antiepileptic drugs (AEDs) such as levetiracetam 2, 3
- Approximately 50-90% of patients with brain tumors and seizures may experience a reduction in seizure frequency with AED treatment 3
- Some patients may achieve complete seizure control with AED treatment 3
Pathophysiology of Tumor-Related Seizures
The underlying mechanisms of tumor-related seizures are not fully understood, but may involve:
- Altered peritumoral amino acids, regional metabolism, pH, and neuronal or glial enzyme and protein expression 4
- Changed distribution and function of N-methyl-d-aspartate subclass of glutamate receptors 4
- Immunologic activity and tumor growth 4
Treatment Challenges
Treatment of tumor-related seizures can be challenging due to: