Helen Lacey Seizures Draft1 29 Mar 2010

8/8/2019 Helen Lacey Seizures Draft1 29 Mar 2010

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Seizures and brain tumours


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Contents

1. What is a seizure?

Types of seizure

Presentation in your Pt

2. Pathogenesis of brain tumour seizures

Location of tumour and seizure symptoms

3. Tumour type and location

4. Management and medication5. Physiotherapy and your Pt

6. Summary


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1. What is a seizure?

Do you know the difference betweenseizures and epilepsy?


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Seizures vs epilepsy

A seizure is defined as: by burst of electrical impulses in the brain escape their

normal limits (past threshold)

they spread to neighbouring areas and create an uncontrolled

storm of cortical nerve cell electrical activity the electrical impulses can be transmitted to the muscles,

causing twitches or convulsions

Seizures are not a disease, they are an event

Epilepsy (seizure disorder) is a neurological condition,that in different times produce brief disturbances in theelectrical functions of the brain

Seizures are a symptom of epilepsy


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Types of seizure

Partial

begin locally in one part of the brain

Generalised

bilaterally symmetric

no local onset and although they involve theentire brain, physical control is rarely lost


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Partial and generalised seizures

Partial seizure with secondary

generalization

Primary

generalised

seizurePartial seizure


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Partial seizures

Simple partial seizure

consciousness not impaired

Complex partial seizure

consciousness impaired

Secondary generalised seizure

begins as partial and transitions into a generalised

seizure


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Generalised seizures

i. Absence seizures (petit mal)- staring, slightbody movement and short periods ofunawareness

ii. Myoclonic seizures- sudden jerks of arms andlegs

iii. Atonic seizures (drop attacks)- suddenlycollapse or fall down

iv. Tonic-clonic seizures (grand mal)- most

severe type of seizure; characterized by lossof consciousness, body stiffening, shakingand sometimes tongue biting or bladderincontinence


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Seizure presentation in your

patient


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Simple Partial Seizures


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Complex Partial Seizures


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2. Pathogenesis of seizures


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Pathogenesis of brain tumour-

associated seizures Pathogenesis is poorly understood

Slow-growing benign tumours cause more seizureproblems than malignant tumours which rapidly destroy

nearby neurones instead of stimulating them4

Slow-growing tumours may cause seizures by focal orremote cell changes3

Alteration in peritumoural amino acids

Regional cell metabolism pH

Protein expression


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3. Tumour type and location


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Tumour type

Seizure risk is associated with grade of

primary brain tumour

Higher risk of having seizures in low-gradeprimary brain tumour, astrocytoma,

oligodendroglioma, meningioma

Lower risk of having seizures in high-grade

primary brain tumour, anaplastic astrocytoma,glioblastoma


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Tumour location

Most important predictor of seizures

Seizures more common with supratentorial than

infratentorial tumours

Cortical tumour main predictor for development of

epilepsy

Tumours affecting frontal, temporal and parietal lobes

more commonly associated with seizures than occipital5


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Seizure prevalence

Any type of brain tumor can cause seizures

Seizures are the presenting sign in 30-50% of Pt with

a brain tumour

10-30% of Pts will develop seizures later in diseasecourse1

25% of Pts with meningioma present with

seizures2

20% of Pts with meningioma, without a history of

seizure, will develop seizures post-surgery2


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Prognosis

Large studies have found no effect of seizures on

survival WHAT KIND OF STUDY?

Presentation with a seizure is a favourable prognosticsign

Earlier diagnosis

Surgically accessible

Over-representation of Pts with lower grade tumours


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4. Management and

medication


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Medication

Antiepileptic drugs (AEDs)

Drug therapy goal: to prevent seizures with the lowest effective doses of AEDs with

the least side effects

Commonly used AEDs: Carbamazepine (Tegretol)

Gabapentin (Neurontin) Oxycarbazepine (Trileptal )

Phenobarbital (Luminal)

Phenytoin (Dilantin )


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AESs: The first line of defence

36%

4%

13%

47%

ha ac es s a e e sy e e- ee w h multiple drugs

eizure- reewith sec d or third drug Seizure- reewith first drug


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AEDs first line of defence

Wen (2002)


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Side effects of AEDs

Side effects are more frequent in Pts with brain tumours

compared with people with epilepsy6

Some AEDs can interfere with chemotherapeutic agentsand corticosteroids eg, dexamethasone reducing their

efficacy7

Drowsiness/dizziness

Ataxia

Cognitive impairment

Dermatological reactions


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Surgery

Focal area of brain causing the seizures

area may be removed without producing new problem

Resection of tumour not always sufficient to stop the seizures (seizures do

not arise from tumour tissue, but from damaged or

malfunctioning adjacent tissue)


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Vagal nerve stimulator (VNS)

VNS is implanted to control

seizures by delivering

electrical stimulation to the

Xth cranial nerve in the

neck, which relays impulsesto widespread areas of the

brain

Used to treat partial

seizures when medication

does not work


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VNS and quality of life

Less severe or shorter seizures

Improved post-ictal period

Better mood Improved alertness

Improved memory/cognition


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5. Physiotherapy treatment

and seizures


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Your Pt may

Have experienced seizures prior to Dx-what is theirpresenting sign?

Develop seizures during tumour Rx at any stage

Have communication problems

Focal facial seizures Have communcation problems

Be receiving AEDs to control seizures

Affecting their attention, cognition, balance

Check your Pts notes thoroughly prior to considering Rx plan Ensure you choose your Rx environment carefully

Ensure that if there is a bone-flap deficit that head protectionis worn continuously


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Summary

Seizures can be the first sign of a brain tumour

Seizures can develop at any stage during treatment

Seizures can have a profound affect on a Pts quality oflife

Seizures and subsequent AED medication may affect

how you treat

where you send your Pt for post-surgery rehabilitation


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References

1. Van Vellen et al. J Neurol Neurosurg Psychiatry1998;64: 581-7

2. Lieu & Howng (2000). Epilepsy Res 38:45-52

3. Herman. Neurology 2002;59(suppl):S21-26

4. Riva. Neurol Sci2005;26(suppl) S40-42

5. Sirven et al. Mayo Clin Proc2004;79:1489-946. Wen & Marks. Curr Opin Oncol2002;14:299-307

7. Hauser et al. Epilepsia 1993;34:453-68

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Helen Lacey Seizures Draft1 29 Mar 2010

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