Choosing the tumoral epilepsy surgery candidate

New classification of epilepsy-related neoplasms: The clinical perspective

Neoplastic CNS lesions are a common cause of focal epilepsy refractory to anticonvulsant treatment, i.e. long-term epilepsy-associated tumors (LEATs). Epileptogenic tumors encompass a variety of intriguing lesions, e.g. dysembryoplastic neuroepithelial tumors or gangliogliomas, which differ from more common CNS neoplasms in their clinical context as well as on histopathology. Long-term epilepsy-associated tumor classification is a rapidly evolving issue in surgical neuropathology, with new entities still being elucidated. One major issue to be resolved is the inconsistent tissue criteria applied to LEAT accounting for high diagnostic variability between individual centers and studies, a problem recently leading to a proposal for a new histopathological classification by Blümcke et al. in Acta Neuropathol. 2014; 128: 39-54. While a new approach to tissue diagnosis is appreciated and needed, histomorphological criteria alone will not suffice and we here approach the situation of encountering a neoplastic lesion in an epilepsy patient from a clinical perspective. Clinical scenarios to be supported by an advanced LEAT classification will be illustrated and discussed.

Seizure management in patients with gliomas

Seizures represent a major cause of morbidity in patients diagnosed with brain tumors. Seizures in patients with gliomas are disruptive, impact on quality of life; autonomy; the capacity to operate motor vehicles and opportunities for work. The management of seizures in patients with brain tumors is complex and ideally managed in a multidisciplinary fashion. In addition to antiepileptic drugs, surgery, chemotherapy and radiotherapy have potential roles in the management of a glioma patient with intractable epilepsy. The successful management of seizures in patients with brain tumors is possible, it provides considerable benefits in terms of quality of life and should remain a central goal in patient management.

Tumor-related epilepsy and epilepsy surgery

Tumor-related epilepsy (TRE) is a major etiologic category of epilepsy. TRE is heterogeneous, and the epidemiology, pathology, pathophysiology, clinical features, treatment, and outcomes vary accordingly. In addition, treatment imperatives vary between almost purely epilepsy considerations and those that are primarily oncologic. Often, there is no clear separation of imperatives, and there is a relatively scant evidence base that underpins management decisions in such cases. Given a diverse molecular as well as clinical landscape and the rapid pace with which new knowledge accrues, there are relatively few recent literature resources on TRE that provide neurologists, neurosurgeons, epileptologists, and oncologists with an up-to-date, state-of-the-art review of the field in all of its important aspects. The proceedings of the Sixth International Epilepsy Colloquium in Cleveland in Ohio, U.S.A., in May 2013 on Tumoral Epilepsy and Epilepsy Surgery address, at least in part, several TRE aspects crucial to modern epilepsy and oncology practice.