Document Type : Original Article
Authors
1
Associate Professor of Neurology, Fellowship of Epilepsy, Mazandaran University of Medical Sciences, Sari, Iran
2
Student Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
3
Associate Professor of Neurological Surgery, Mazandaran University of Medical Sciences, Sari, Iran
Abstract
Brain tumor-related epilepsy (BTRE) is a prevalent complication, affecting 25-60% of patients with primary or metastatic brain tumors, significantly impacting quality of life and complicating oncologic management. This narrative review examines factors influencing the effectiveness of levetiracetam (LEV), lamotrigine (LTG), and lacosamide (LCS) in BTRE. By analyzing epidemiological data, pathophysiological mechanisms, pharmacological profiles, and clinical evidence, we study how tumor characteristics (type, location, molecular profile), patient-specific factors (age, comorbidities), drug interactions, and pharmacodynamic properties modulate seizure control. LEV is often the first-line choice due to its favorable tolerability and minimal drug interactions, achieving seizure freedom in 65-80% of patients in some studies. LTG and LCS, effective as monotherapy or add-on therapies with response rates of 50-70%, vary in efficacy based on tumor histology and peritumoral microenvironment. Challenges include drug resistance linked to glutamate excitotoxicity, sodium channel dysregulation, and tumor-driven molecular changes. Research gaps, such as long-term comparative trials and personalized dosing strategies, highlight the need for further investigation. Optimizing AED selection in BTRE requires a multidisciplinary approach to balance seizure control, antitumor therapy efficacy, and adverse effect minimization, emphasizing personalized medicine.
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