New-Onset Seizure in Patient with Cancer - Case of the Week
Try this free seizure disorders case Q&A courtesy of Med-Challenger.
A 49-year-old man with small-cell lung cancer presents with a new-onset seizure that occurred at home.
Computed tomography (CT) of the brain shows a low attenuation area in the right parietal area (see Figure 1).
Which of the following statements are correct about seizures in patients with cancer?
- Seizures are more common with brain tumors in the parietal, temporal, or frontal lobe than the occipital lobe.
- High-grade tumors, such as glioblastoma multiforme or metastatic brain tumors, are more likely to cause seizures than low-grade and slow-growing primary brain neoplasms.
- The incidence of seizures in patients with brain metastases is 70% to 80%.
- Use of chemotherapy may cause seizures.
See Full Answer
The correct answer is:
Seizures are more common with brain tumors in the parietal, temporal, or frontal lobe than the occipital lobe.
Identify risk factors for the development of seizures in patients with cancer.
Seizures are most common when cancer (primary or metastatic) is located near the cortex in the parietal, temporal, or frontal lobe.
Seizures are more common in patients with primary or metastatic cancer located near the cortex of the parietal, temporal, or frontal lobes of the brain. The incidence of seizures in patients with metastatic brain cancer is approximately 35% (not 70%-80%).
Seizure prophylaxis in patients with cancer and brain lesions is not indicated if he or she has no history of seizures. A review article concluded that there was no difference between placebo and treatment with phenobarbital, phenytoin, or valproic acid in preventing a first seizure; moreover, adverse events were more frequent with antiseizure drug therapy.
Primary brain neoplasms, especially low-grade and slow-growing (such as gliomas and oligodendrogliomas), cause seizures more often than high-grade tumors such as glioblastoma multiforme or metastatic brain tumors.
It is unlikely for chemotherapy to induce seizure activity.
Ertürk Çetin Ö, İşler C, Uzan M, Özkara Ç. Epilepsy-related brain tumors. Seizure. 2017;44:93-97.
Drappatz J, Wen PY, Avila EK. Seizures in patients with primary and metastatic brain tumors. Updated June 14, 2018. Accessed August 8, 2018.
Rabin E, Jagoda A. Seizures (chapter 92). In: Wall R, et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed., 2018:1256-1264.
Kerrigan S, Grant R. Antiepileptic drugs for treating seizures in adults with brain tumours. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD008586. DOI: 10.1002/14651858.CD008586.pub2.
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