TY - JOUR
T1 - Epilepsy and brain tumors
T2 - Two sides of the same coin
AU - Aronica, Eleonora
AU - Ciusani, Emilio
AU - Coppola, Antonietta
AU - Costa, Cinzia
AU - Russo, Emilio
AU - Salmaggi, Andrea
AU - Perversi, Fabio
AU - Maschio, Marta
N1 - Funding Information: The authors wish to acknowledge Aashni Shah and Valentina Attanasio (Polistudium Srl, Milan, Italy) for linguistic and editorial assistance. Medical writing, editorial and linguistic revisions were supported by Eisai . Publisher Copyright: © 2023 The Authors
PY - 2023/3/15
Y1 - 2023/3/15
N2 - Epilepsy is the most common symptom in patients with brain tumors. The shared genetic, molecular, and cellular mechanisms between tumorigenesis and epileptogenesis represent ‘two sides of the same coin’. These include augmented neuronal excitatory transmission, impaired inhibitory transmission, genetic mutations in the BRAF, IDH, and PIK3CA genes, inflammation, hemodynamic impairments, and astrocyte dysfunction, which are still largely unknown. Low-grade developmental brain tumors are those most commonly associated with epilepsy. Given this strict relationship, drugs able to target both seizures and tumors would be of extreme clinical usefulness. In this regard, anti-seizure medications (ASMs) are optimal candidates as they have well-characterized effects and safety profiles, do not increase the risk of developing cancer, and already offer well-defined seizure control. The most important ASMs showing preclinical and clinical efficacy are brivaracetam, lacosamide, perampanel, and especially valproic acid and levetiracetam. However, the data quality is low or limited to preclinical studies, and results are sometimes conflicting. Future trials with a prospective, randomized, and controlled design accounting for different prognostic factors will help clarify the role of these ASMs and the clinical setting in which they might be used. In conclusion, brain tumor-related epilepsies are clear examples of how close, multidisciplinary collaborations among investigators with different expertise are warranted for pursuing scientific knowledge and, more importantly, for the well-being of patients needing targeted and effective therapies.
AB - Epilepsy is the most common symptom in patients with brain tumors. The shared genetic, molecular, and cellular mechanisms between tumorigenesis and epileptogenesis represent ‘two sides of the same coin’. These include augmented neuronal excitatory transmission, impaired inhibitory transmission, genetic mutations in the BRAF, IDH, and PIK3CA genes, inflammation, hemodynamic impairments, and astrocyte dysfunction, which are still largely unknown. Low-grade developmental brain tumors are those most commonly associated with epilepsy. Given this strict relationship, drugs able to target both seizures and tumors would be of extreme clinical usefulness. In this regard, anti-seizure medications (ASMs) are optimal candidates as they have well-characterized effects and safety profiles, do not increase the risk of developing cancer, and already offer well-defined seizure control. The most important ASMs showing preclinical and clinical efficacy are brivaracetam, lacosamide, perampanel, and especially valproic acid and levetiracetam. However, the data quality is low or limited to preclinical studies, and results are sometimes conflicting. Future trials with a prospective, randomized, and controlled design accounting for different prognostic factors will help clarify the role of these ASMs and the clinical setting in which they might be used. In conclusion, brain tumor-related epilepsies are clear examples of how close, multidisciplinary collaborations among investigators with different expertise are warranted for pursuing scientific knowledge and, more importantly, for the well-being of patients needing targeted and effective therapies.
KW - Anti-epileptic drug
KW - Anti-seizure medication
KW - Brain tumor
KW - Brain tumor-related epilepsy
KW - Drug repurposing
KW - Epilepsy
KW - Glioblastoma
UR - http://www.scopus.com/inward/record.url?scp=85148715842&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jns.2023.120584
DO - https://doi.org/10.1016/j.jns.2023.120584
M3 - Review article
C2 - 36842341
SN - 0022-510X
VL - 446
JO - Journal of the neurological sciences
JF - Journal of the neurological sciences
M1 - 120584
ER -