Specific treatment of epileptic seizures in brain tumor: case report

Different methods of treating brain tumors can be proepileptic (surgical lesions, chemotherapeutics vincristine and methotrexate) or antiepileptic (chemotherapeutic temozolomide). Radiation therapy can act in two ways. Chemotherapeutics and some conventional antiepileptic drugs (phenytoin, carbamazepine, phenobarbital, valproic acid) have the same metabolic pathway through the liver enzymes cytochrome P450.This may lead to drug interactions. The aim is to describe the complexity of the treatment of epileptic seizures in an 11-year-old patient with a brain tumor. Now the 11-year-old boy was healthy until age of 7 years, except for mild headache he complained on several occasions. Then he suff ered the fi rst seizure, grand mal type. He was diagnosed with pilocytic astrocytoma in the hypothalamic region. Due to obstructive hydrocephalus, VP drainage was urgently implanted, and in the second surgery, the tumor was reduced. Consequently, blindness on the right eye and the left eye damage, along with glaucoma developed. Treatment was continued with the chemotherapeutic drugs carboplatin, vinblastine, temozolomide and AED methylphenobarbital. He had no seizures for three years. At the age of 10 years, he suff ered more frequent epileptic seizures, complex partial type. The treatment with methylphenobarbital was discontinued, and valproate and levetiracetam were introduced. The attacks did not stop. Along with AED and CTD, he was taking multiple diff erent medicines. The treatment of epileptic seizures in brain tumors requires an interdisciplinary approach. The children who are being treated with chemotherapeutics are recommended to use drugs that do not induce/inhibit the enzymatic system of the liver. These are levetiracetam, lamotrigine and gabapentin. Increased caution is required with use of valproic acid.

Keywords: seizures; brain neoplasms; drug interactions; anticonvulsants; child
Category: Case report
Volume: Vol. 57, No 2, april - june 2013
Authors: Popović Miočinović Lj., Bošnjak Nađ K., Mladin Čikara M., Stepan Giljević J.
Reference work: Paediatr Croat. 2013;57:171-5

Read more