Seizures in patients with cancer

• Published in: Cancer 2020-04, Vol.126 (7), p.1379-1389
• Main Authors: Gonzalez Castro, L. Nicolas, Milligan, Tracey A.
• Format: Article
• Language: English
• Subjects: Antiepileptic agents; antiepileptic drugs; Benzodiazepines; Brain cancer; brain tumor; Cancer; Cancer therapies; Chemotherapy; Complications; Convulsions & seizures; EEG; Epilepsy; Medical imaging; Neuroimaging; Oncology; Patients; Quality of life; Radiation; Radiation therapy; Seizures; Surgery
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.32708

Seizures are common in patients with cancer and either result from brain lesions, paraneoplastic syndromes, and complications of cancer treatment or are provoked by systemic illness (metabolic derangements, infections). Evaluation should include a tailored history, neurologic examination, laboratory studies, neuroimaging, and electroencephalogram. In unprovoked seizures, antiepileptic drug (AED) treatment is required, and a nonenzyme‐inducing AED is preferred. Treatment of the underlying cancer with surgery, chemotherapy, and radiation therapy also can help reduce seizures. Benzodiazepines are useful in the treatment of both provoked seizures and breakthrough epileptic seizures and as first‐line treatment for status epilepticus. Counseling for safety is an important component in the care of a patient with cancer who has seizures. Good seizure management can be challenging but significantly improves the quality of life during all phases of care, including end‐of‐life care. Seizures are common in patients with cancer. Given the marked disability that can result from poorly controlled seizures, patients with cancer who have seizures require effective seizure management.