Skip to main content
SpringerLink
Log in

Brain Tumors and ICU Seizures

  • Chapter
Seizures in Critical Care

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 764 Accesses

Abstract

Seizures are a common presentation of brain neoplasms. Both primary brain tumors and metastases can present with seizures, which are more commonly focal depending on the location and the pathology of the lesion. In general, more benign tumors have higher incidence of seizures than more malignant ones. These patients are admitted to an intensive care unit either for preoperative monitoring or in the postoperative period. They should be treated with antiepileptics if seizures are witnessed. Whether they should be prophylactically treated with antiepileptic medications if seizures have not occurred yet in the pre- and postoperative period, and for how long, are questions that remain to be answered. More recent data do not seem to support such prophylactic administration.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ziai WC, Varelas PN, Zeger SL, Mirski MA, Ulatowski JA. Neurologic intensive care resource use after brain tumor surgery: an analysis of indications and alternative strategies. Crit Care Med 2003;31:2782–2787.

    Article  PubMed  Google Scholar 

  2. LeBlanc F, Rasmussen T. Cerebral seizures and brain tumors. In: Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology. Amsterdam: Elsevier Science Publishers: 1974:295–301.

    Google Scholar 

  3. Cascino G. Epilepsy and brain tumors: implications for treatment. Epilepsia 1990;31(suppl 3): S37–S44.

    Article  PubMed  Google Scholar 

  4. Bartolomei J, Christopher S, Vives K, Spencer DD, Piepmeier JM. Low grade gliomas of chronic epilepsy: a distinct clinical and pathological entity. J Neurooncol 1997;34:79–84.

    Article  PubMed  CAS  Google Scholar 

  5. McKeran R, Thomas DGT. The clinical study of gliomas. In: Thomas D, Graham DL, eds. Brain Tumors: Scientific Basis, Clinical Investigation and Current Therapy. Baltimore: 1980:194–230.

    Google Scholar 

  6. Cohen N, Strauss G, Lew R, Silver R, Recht L. Should prophylactic anticonvulsants be administered to patients with newly diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988;6:1621–1624.

    PubMed  CAS  Google Scholar 

  7. Simonescu M. Metastatic tumors of the brain. A follow-up study of 195 patients with neurosurgical considerations. J Neurosurg 1960;17:361–373.

    Google Scholar 

  8. Ketz E. Brain tumors and epilepsy. In: Vinken P, Bruyn GW, eds. Handbook of Clinical Neurology.Amsterdam: Elsevier Science Publishers: 1974:254–269.

    Google Scholar 

  9. Moots P, Maciunas RJ, Eisert DR, Parker RA, Laporte K, Abou-Khalil B. The course of seizure disorders in patients with malignant gliomas. Arch Neurol 1995;52:717–724.

    PubMed  CAS  Google Scholar 

  10. Whittle I, Beaumont A. Seizures in patients with supratentorial oligodendroglial tumours; clinicopathological features and management considerations. Acta Neurochir (Wien) 1995;135:19–24.

    Article  CAS  Google Scholar 

  11. Rasmussen T, Blundell J. Epilepsy and brain tumours. Clin Neurosurg 1959;7:138–158.

    PubMed  CAS  Google Scholar 

  12. Hoefer P, Schlesinger EB, Peress HH. Seizures in patients with brain tumours. Res Nerv Ment Dis Proc 1947;26:50–58.

    Google Scholar 

  13. Morris H, Estes ML, Prayson RA, et al. Frequency of different tumor types encountered in the Cleveland Clinic epilepsy surgery program. Epilepsia 1996;37:96.

    Article  Google Scholar 

  14. Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir (Wien) 2000; 142:1–15.

    Article  CAS  Google Scholar 

  15. Scott G, Gibberd FB. Epilepsy and other factors in the prognosis of gliomas. Acta Neurol Scand 1980; 61:227–239.

    PubMed  CAS  Google Scholar 

  16. Mahaley MJ, Dudka L. The role of anticonvulsant medications in the management of patients with anaplastic gliomas. Surg Neurol 1981;16:399–401.

    Article  PubMed  Google Scholar 

  17. Victor M, Ropper AH. Principles of Neurology. New York: McGraw-Hill: 2001.

    Google Scholar 

  18. Kvam D, Loftus CM, Copeland B, Quest DO. Seizures during the immediate postoperative period. Neurosurgery 1983;12:14–17.

    Article  PubMed  CAS  Google Scholar 

  19. Lee S, Lui TN, Chang CN, Cheng WC. Early postoperative seizures after posterior fossa surgery. J Neurosurg 1990;73:541–544.

    PubMed  CAS  Google Scholar 

  20. North JB, Penhall RK, Hanieh A, Frewin DB, Taylor WB. Phenytoin and postoperative epilepsy—a double blind study. J Neurosurg 1983;58:672–677.

    PubMed  CAS  Google Scholar 

  21. Fukamachi A, Koizumi H, Nukui H. Immediate postoperative seizures—incidence and computed tomographic findings. Surg Neurol 1985;24:671–676.

    Article  PubMed  CAS  Google Scholar 

  22. Ellenbogen RG, Winston KR, Kupsky WJ. Tumors of the choroid plexus in children. Neurosurgery 1989; 25(3); 397–335.

    Google Scholar 

  23. Sato T, Takeichi M, Abe M, Tabuchi K, Hara T. Frontal lobe tumor associated with late-onset seizure and psychosis: a case report. Jpn J Psychiatry Neurol 1993;47:541–544.

    PubMed  CAS  Google Scholar 

  24. Ettinger A. Structural causes of epilepsy. Tumors, cysts, stroke, and vascular malformations. Neurol Clin 1994;12:41–56.

    PubMed  CAS  Google Scholar 

  25. McKinney R, Debanne D, Gahwiler BH, et al. Lesion induced axonal sprouting and hyperexcitability in the hippocampus in vitro. Implications for the genesis of posttraumatic epilepsy. Nat Med 1997;3:990–996.

    Article  PubMed  CAS  Google Scholar 

  26. Gray W, Sundstrom LE. Kainic acid increases the proliferation of granule cell progenitors in the dentate gyrus of the rat. Brain Res 1998;790:52–59.

    Article  PubMed  CAS  Google Scholar 

  27. Echlin F. The supersensitivity of chronically “isolated” cerebral cortex as a mechanism in focal epilepsy. Electroencephalog Clin Neurophysiol 1959;11:697–732.

    Article  CAS  Google Scholar 

  28. Patt S, Labrakakis C, Bernstein M, et al. Neuron-like physiological properties of cells from human oligodendroglial tumors. Neuroscience 1996; 71:601–611.

    Article  PubMed  CAS  Google Scholar 

  29. Labrakakis C, Patt S, Weydt P, et al. Action potential generating cells in human glioblastoma. J Neuropathol Exp Neurol 1997;56:243–254.

    PubMed  CAS  Google Scholar 

  30. Goldstein D, Nadi NS, Stull R, Wyler AR, Porter RJ. Levels of catechols in epileptogenic and nonepileptogenic regions of the human brain. J Neurochem 1988;50:225–229.

    Article  PubMed  CAS  Google Scholar 

  31. Kish S, Dixon LM, Sherwin AL. Aspartic acid aminotransferase activity is increased in actively spiking compared with non-spiking cortex. J Neurol Neurosurg Psychiatry 1988;51:552–556.

    PubMed  CAS  Google Scholar 

  32. Sherwin A, Vernet O, Dubeau F, Olivier A. Biochemical markers of excitability in human neocortex. Can J Neurol Sci 1991;18:640–644.

    PubMed  CAS  Google Scholar 

  33. Avoli M, Drapeau C, Pumain R, Olivier A, Villemure J-G. Epileptiform activity induced by low extracellular magnesium in the human cortex maintained in vitro. Ann Neurol 1991;30:589–596.

    Article  PubMed  CAS  Google Scholar 

  34. Okada Y, Kloiber O, Hossman KA. Regional metabolism in experimental brain tumors in cats: relationship with acid/base, water and electrolyte homeostasis. J Neurosurg 1992;77:917–926.

    PubMed  CAS  Google Scholar 

  35. Alger J, Frank JA, Bizzi A, et al. Metabolism of human gliomas: assessment with H-1 MR spectroscopy and F-18 fluorodeoxyglucose PET. Radiology 1990;177:633–641.

    PubMed  CAS  Google Scholar 

  36. Neuwelt E, Goldman DL, Dahlborg SA, et al. Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function. J Clin Oncol 1991;9:1580–1590.

    PubMed  CAS  Google Scholar 

  37. Lukovits TG, Fadul CE, Pipas JM, Williamson PD. Nonconvulsive status epilepticus after intravenous contrast medium administration. Epilepsia 1996;37:1117–1120.

    Article  PubMed  CAS  Google Scholar 

  38. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–240.

    Article  PubMed  Google Scholar 

  39. McDonald GA, Dubose TD, Jr. Hyponatremia in the cancer patient. Oncology (Huntington) 1993;7: 55–64; discussion 67,68,70,71.

    CAS  Google Scholar 

  40. Meropol NJ, Creaven PJ, Petrelli NJ, White RM, Arbuck SG. Seizures associated with leucovorin administration in cancer patients. J Natl Cancer Inst 1995;87:56–58.

    Article  PubMed  CAS  Google Scholar 

  41. Delanty N, Vaughan CJ, French JA. Medical causes of seizures. Lancet 1998;352:383–390.

    Article  PubMed  CAS  Google Scholar 

  42. Dalmau J, Graus F, Rosenblum MK, Posner JB. Anti-Hu-associated paraneoplastic encephalomyelitis/sensory neuronopathy. A clinical study of 71 patients. Medicine (Baltimore) 1992;71:59–72.

    CAS  Google Scholar 

  43. Drislane FW. Nonconvulsive status epilepticus in patients with cancer. Clin Neurol Neurosurg 1994; 96:314–318.

    Article  PubMed  CAS  Google Scholar 

  44. Cocito L, Audenino D, Primavera A. Altered mental state and nonconvulsive status epilepticus in patients with cancer. Arch Neurol 2001;58:1310.

    Article  PubMed  CAS  Google Scholar 

  45. Jordan KG. Nonconvulsive status epilepticus in acute brain injury. J Clin Neurophysiol 1999;16: 332–340; discussion 353.

    Article  PubMed  CAS  Google Scholar 

  46. Jordan KG. Continuous EEG monitoring in the neuroscience intensive care unit and emergency department. J Clin Neurophysiol 1999;16:14–39.

    Article  PubMed  CAS  Google Scholar 

  47. Primavera A, Audenino D, Cocito L. Ifosfamide encephalopathy and nonconvulsive status epilepticus. Can J Neurol Sci 2002;29:180–193.

    PubMed  Google Scholar 

  48. Glantz MJ, Cole BF, Forsyth PA, et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;54:1886–1893.

    PubMed  CAS  Google Scholar 

  49. Schaller B, Ruegg SJ. Brain tumor and seizures: pathophysiology and its implications for treatment revisited. Epilepsia 2003;44:1223–1232.

    Article  PubMed  Google Scholar 

  50. Cockey GH, Amann ST, Reents SB, Lynch JW, Jr. Stevens-Johnson syndrome resulting from whole-brain radiation and phenytoin. Am J Clin Oncol 1996;19:32–34.

    Article  PubMed  CAS  Google Scholar 

  51. Glantz MJ, Cole BF, Friedberg MH, et al. A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumors. Neurology 1996;46:985–991.

    PubMed  CAS  Google Scholar 

  52. Deutschman C, Haines SJ. Anticonvulsant prophylaxis in neurological surgery. Neurosurgery 1985;17: 510–516.

    Article  PubMed  CAS  Google Scholar 

  53. Lee S, Lui TN, Chang CN, Cheng WC, Wang DJ, Heimbarger RF, Lin CG. Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures. Surg Neurol 1989;31:361–364.

    Article  PubMed  CAS  Google Scholar 

  54. Foy PM, Chadwick DW, Rajgopalan N, Johnson AL, Shaw MD. Do prophylactic anticonvulsant drugs alter the pattern of seizures after craniotomy? J Neurol Neurosurg Psychiatry 1992;55:753–757.

    Article  PubMed  CAS  Google Scholar 

  55. Beenen LF, Lindeboom J, Kasteleijn-Nolst Trenite DG, et al. Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects. J Neurol Neurosurg Psychiatry 1999;67:474–480.

    PubMed  CAS  Google Scholar 

  56. Kuijlen JM, Teernstra OP, Kessels AG, Herpers MJ, Beuls EA. Effectiveness of antiepileptic prophylaxis used with supratentorial craniotomies: a meta-analysis. Seizure 1996;5:291–298.

    Article  PubMed  CAS  Google Scholar 

  57. Franceschetti S, Binelli S, Casazza M, et al. Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumours. Acta Neurochir (Wien) 1990;103:47–51.

    Article  CAS  Google Scholar 

  58. Forsyth PA, Weaver S, Fulton D, et al. Prophylactic anticonvulsants in patients with brain tumour. Can J Neurol Sci 2003;30:106–112.

    PubMed  Google Scholar 

  59. Hung S, Hilsenbeck S, Feun L. Seizure prophylaxis with phenytoin in patients with brain metastasis. Proc Am Soc Clin Oncol 1991;10:327.

    Google Scholar 

  60. Patsalos PN, Froscher W, Pisani F, van Rijn CM. The importance of drug interactions in epilepsy therapy. Epilepsia 2002;43:365–385.

    Article  PubMed  CAS  Google Scholar 

  61. Sylvester RK, Lewis FB, Caldwell KC, Lobell M, Perri R, Sawchuk RA. Impaired phenytoin bioavailability secondary to cisplatinum, vinblastine, and bleomycin. Ther Drug Monit 1984;6:302–305.

    Article  PubMed  CAS  Google Scholar 

  62. Neef C, de Voogd-van der Straaten I. An interaction between cytostatic and anticonvulsant drugs. Clin Pharmacol Ther 1988;43:372–375.

    PubMed  CAS  Google Scholar 

  63. Gattis WA, May DB. Possible interaction involving phenytoin, dexamethasone, and antineoplastic agents: a case report and review. Ann Pharmacother 1996;30:520–526.

    PubMed  CAS  Google Scholar 

  64. Bittigau P, Sifringer M, Genz K, et al. Antiepileptic drugs and apoptotic neurodegeneration in the developing brain. Proc Natl Acad Sci USA 2002;99:15,089–15,094.

    Article  PubMed  CAS  Google Scholar 

  65. Blaheta RA, Cinatl J, Jr. Anti-tumor mechanisms of valproate: a novel role for an old drug. Med Res Rev 2002;22:492–511.

    Article  PubMed  CAS  Google Scholar 

  66. Bardana EJ, Jr, Gabourel JD, Davies GH, Craig S. Effects of phenytoin on man’s immunity. Evaluation of changes in serum immunoglobulins, complement, and antinuclear antibody. Am J Med 1983;74:289–296.

    Article  PubMed  Google Scholar 

  67. Kikuchi K, McCormick CI, Neuwelt EA. Immunosuppression by phenytoin: implication for altered immune competence in brain-tumor patients. J Neurosurg 1984;61:1085–1090.

    PubMed  CAS  Google Scholar 

  68. Weissman DE. Glucocorticoid treatment for brain metastases and epidural spinal cord compression: a review. J Clin Oncol 1988;6:543–551.

    PubMed  CAS  Google Scholar 

  69. Guttuso T, Jr, Roscoe J, Griggs J. Effect of gabapentin on nausea induced by chemotherapy in patients with breast cancer. Lancet 2003;361:1703–1705.

    Article  PubMed  CAS  Google Scholar 

  70. Eralp Y, Aydiner A, Tas F, Saip P, Topuz E. Stevens-Johnson syndrome in a patient receiving anticonvulsant therapy during cranial irradiation. Am J Clin Oncol 2001;24:347–350.

    Article  PubMed  CAS  Google Scholar 

  71. Esteve E, Favre A, Martin L. Post-radiotherapy eruption in a patient treated with valproic acid. Rowell’s syndrome? Ann Dermatol Venereol 2002;129:901–903.

    PubMed  CAS  Google Scholar 

  72. Mamon HJ, Wen PY, Burns AC, Loeffler JS. Allergic skin reactions to anticonvulsant medications in patients receiving cranial radiation therapy. Epilepsia 1999;40:341–344.

    Article  PubMed  CAS  Google Scholar 

  73. Smith DF, Hutton JL, Sandemann D, et al. The prognosis of primary intracerebral tumours presenting with epilepsy: the outcome of medical and surgical management. J Neurol Neurosurg Psychiatry 1991;54:915–920.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA

    Efstathios Papavassiliou MD

  2. Neurointensive Care Unit, and Department of Neurology, Medical College of Wisconsin, Milwaukee, WI

    Panayiotis N. Varelas MD, PhD

  3. Neurointensive Care Unit, and Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI

    Panayiotis N. Varelas MD, PhD

Authors
  1. Efstathios Papavassiliou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Panayiotis N. Varelas MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Neurointensive Care Unit, and Department of Neurology, Medical College of Wisconsin, Milwaukee, WI

    Panayiotis N. Varelas MD, PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Papavassiliou, E., Varelas, P.N. (2005). Brain Tumors and ICU Seizures. In: Varelas, P.N. (eds) Seizures in Critical Care. Current Clinical Neurology. Humana Press. https://doi.org/10.1007/978-1-59259-841-0_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-841-0_4

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-342-8

  • Online ISBN: 978-1-59259-841-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation