Seizures and epilepsy in oncological practice: causes, course, mechanisms and treatment

[D.ap]

Abstract

There are few data available on the causes and mechanistic basis, outcome and treatment of seizures and epilepsy in people with systemic cancer. Seizures and epilepsy in people with cancers other than primary brain tumours are reviewed here. Articles published in English, which discussed the neurological manifestations and complications of cancer and its treatment, were searched and information on the frequency, aetiology, and course of seizures and epilepsy was extracted. The frequency, aetiology and outcome of seizure disorders in patients with cancer differ from those in the general population. Intracranial metastasis, cancer drugs and metabolic disturbances are the most common causes. Infections, cerebrovascular complications of systemic cancer and paraneoplastic disorders are among the rarer causes of seizures in patients with neoplasms. Several drugs used in the treatment of cancer, or complications arising from their use, can trigger seizures through varied mechanisms. Most drug‐induced seizures are provoked and do not require long‐term treatment with antiepileptic drugs.

Epilepsy and seizures are among the most common neurological conditions affecting all ages. The overall incidence of epilepsy in developed countries is about 50/100 000 persons/year, and the cumulative lifetime incidence of seizures is over 10%.1,2 Likewise, cancer, another common medical condition, affects one in three people overall. In all, over 270 000 new cases of cancer were registered in the UK in 2000. Cancer is the cause of 26% of the deaths in the UK, and outnumbers heart disease as a cause of death.3 Seizures and epilepsy may therefore occur, coincidentally or otherwise, in some people with cancer, and the cancer may influence the incidence, treatment and prognosis of seizures and epilepsy.

We recently reviewed the comorbidity of cancer in people with epilepsy.4 Here we discuss the causes, outcome and treatment of seizures and epilepsy in people with neoplasms. This review focuses on the occurrence of seizures and epilepsy in people with systemic cancer, and excludes brain tumours as these have been discussed elsewhere.5,6 Mechanistic considerations involving cancer drug‐induced seizures are discussed in some detail, as these have not received much attention so far. Neurologists should be aware of the unique set of causes of seizures in people with cancer, as well as their outcome and treatment, especially as the occurrence of seizures in a patient with cancer often prompts neurological consultation.




https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077803/

[D.ap]

I felt this to be an important angle to explore , as patients use anti nausea meds etc, to manage cancer Med side affects.

Low blood sodium / and low calcium was an interesting thought as people can drink too much water and create a metabolic imbalance that can resolve its self before a patient knows there was an issue AND or the seizure can happen as the result of this electrolyte imbalanc.



“Metabolic conditions

It is important to recognise toxic–metabolic encephalopathy as a cause of seizures, as the appropriate treatment is correction of the underlying metabolic defect rather than institution of epilepsy drugs. Metabolic disturbances may cause a substantial proportion of seizures in oncological practice, although it may not be possible to identify the exact underlying cause.7,9 Many metabolic disturbances may be drug induced. For instance, both cyclophosphamide and ifosfamide cause inappropriate vasopressin secretion and consequently hyponatraemic seizures, bisphosphonates cause hypocalcaemic seizures, and cisplatin may result in hypomagnesaemia and seizures.20,54,55,56 Rarely, seizures may be the presenting or predominant manifestation of tumours such as insulinoma and phaeochromocytoma.57,58”

[Olga]

Cancer patients on treatment always get the blood work done and electrolytes should be looked at very carefully, of course. They are very tightly regulated in the body and even slight deviation from the norm can cause the real consequences.

[D.ap]

Olga
Agreed if in a timely manner.
I know as a second party( Ie mom of a married and not there first hand when all happens, circumstances ),
ER and all need to ask more questions .
But if folks don’t mention UNTIL they get to their appointments , oh by the way I passed out or had other episodes blackening out etc , then how is the patient being counseled?

What I hate are our folks are falling thru the proverbial cracks of care. Early on. Maybe because they don’t have sarcoma care ?
Just a suggestion
Love