title: Epilepsy in the cancer patient.
abstract: OBJECTIVE
  Epileptic seizures in patients with malignancies usually occur as a consequence of brain metastases from systemic cancer or the presence of a primary brain tumor. Other less-frequent causes include metabolic disorders such as electrolyte abnormalities, hypoglycemia, hypoxia and liver failure, paraneoplastic encephalitis, leptomeningeal carcinomatosis, side effects of certain chemotherapeutic agents, central nervous system infections, and pre-existing epilepsy.
  
  
  METHODS
  We reviewed all published literature in the English language regarding the use of antiepileptic drugs in patients with cancer.
  
  
  RESULTS
  In patients with brain metastases or primary brain tumors that had never experienced seizures, prophylactic anticonvulsant treatment is justified only for a period up to 6 months postoperatively after surgical excision of a cerebral tumor, since approximately half of the patients will never develop seizures and the anti-epileptic drugs may cause toxicity and interactions with antineoplastic therapies. For brief prophylaxis, newer antiepileptic drugs such as levetiracetam and oxcarbazepine are superior to older agents like phenytoin. In patients with a malignancy and seizures, certain antiepileptic drugs that express tumor inhibitory properties should be used such as valproic acid and levetiracetam, followed by oxcarbazepine and topiramate that exhibit good tolerance, efficient seizure control and absence of significant interactions with the chemotherapy.
  
  
  CONCLUSIONS
  Future clinical trials in patients with cancer and epilepsy should focus on combinations of chemotherapeutic interventions with antiepileptic drugs that demonstrate antineoplastic activities.
authors.affiliation: Neurosurgical Research Institute, University of Ioannina, Ioannina, Greece. kargiody@mycosmos.gr
authors.forename: Odysseas
authors.initials: O
authors.lastname: Kargiotis
authors.forename: Sofia
authors.initials: S
authors.lastname: Markoula
authors.forename: Athanasios P
authors.initials: AP
authors.lastname: Kyritsis
mesh_terms: D000818:Animals; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000494:pharmacology; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology / Q000556:secondary; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology*; D006801:Humans
chemical_list: D000927:Anticonvulsants; D000970:Antineoplastic Agents