![]() ![]() We report the specificity of surgical management, functional results and seizure outcome in cases of a tumor location in eloquent areas. High epileptogenicity, childhood epilepsy onset, drug-resistance, temporal location, and seizure freedom after complete resection are common characteristics of both tumors. INTRODUCTION: Dysembryoplastic neuroepithelial tumors and gangliogliomas are developmental glioneuronal tumors usually revealed by partial epilepsy. CONCLUSION: These guidelines are helpful for a rational therapy in tumoral epilepsy. ![]() Discontinuation of anti-epileptic drugs could be considered after successful oncological treatment and a stable medical condition. Late seizures are often related to tumor progression or recurrence. Enzyme-inhibiting drugs could have a favorable effect on survival. New anti-epileptic non-enzyme-inducing drugs are recommended in first-line monotherapy in association with adjuvant oncological therapies. As they may generate adverse effects and interfere with oncological treatments, the choice is based on efficacy, tolerability and potential interactions. Anti-epileptic drugs are not indicated for epilepsy prophylaxis in patients without seizures but only after the first seizure due to high risk of recurrence. ![]() Maximal safe surgical resection is the more effective therapy, alone or combined with adjuvant therapy (chemotherapy, radiotherapy). Seizures can occur as a presenting symptom or during the course of the tumor, including after surgery and oncological treatments. RESULTS: Epilepsy related to supra-tentorial brain tumors is frequent (40-60%) especially in low-grade gliomas, glioneuronal tumors, fronto-temporal and eloquent cortex locations. MATERIAL AND METHODS: Based on studies performed since 2000 we conducted the review by (1) analyzing the incidence of tumoral epilepsy and mechanisms of epileptogenicity (2) describing the current medical and surgical strategy according to oncologic treatments (3) discussing the management of postoperative seizures (4) considering the drug withdrawal after oncologic therapy. We performed a review of current recommendations for the prevention of postoperative seizures and optimizing the anti-epileptic treatment. INTRODUCTION: Epilepsy related to brain tumors is often difficult to treat and may impact the quality of life. Nevertheless, age should not be considered as a limiting factor, especially when good prognostic factors are identified. Even safe it remains at higher risk of complication and population should be carefully selected. CONCLUSIONS: RES is effective procedure in the elderly. Neurological adverse event rate after surgery was 21.1% and 11.7% of patients had neuropsychological adverse effects overall transient. Postoperative number of antiepileptic drugs was significantly lower in the seizure-free group (P=0.001). On the contrary, the need for intracranial exploration was associated with a poorer prognosis (P=0.001). In multivariate analysis, seizure freedom was associated with MRI and neuropathological hippocampal sclerosis (HS) (P=0.009 and P=0.028 respectively), PET hypometabolism (P=0.013), temporal epilepsy (P=0.01). Seizure freedom was not associated with the age at surgery or duration of epilepsy. RESULTS: Over the 147 patients over 50 years (54.9☓.8 years ) coming from 8 specialized French centres for epilepsy surgery, 72.1%, patients were seizure-free and 91.2% had a good outcome 12 months after RES. OBJECTIVE: To evaluate the efficiency of resective epilepsy surgery (RES) in patients over 50 years and determine prognostic factors. ![]()
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