Brain tumour-related epilepsy and its treatment explained by a neurologist

Seizures and brain tumours are complex disorders to understand. Learn from Dr Katia Cikurel, a leading London Neurologist with over 30 years of experience, about how common brain tumour-related epilepsy is, types of tumours, triggers and how the condition is treated.

How common are seizures in people with brain tumours?

Up to two out of three people who have a brain tumour will experience at least one epileptic seizure. This sounds like an extremely high figure, but one must further explain the terms and what this means for those diagnosed with both a brain tumour and an epileptic seizure. It also means that one-third of people with tumours do not ever have a seizure.

Are there types of brain tumours?

Firstly, there are many different types of brain tumour. A brain tumour is a growth in or around your brain. The types of tumour include:

• completely benign tumours (such as grade 1 meningiomas)
• low-grade, slow-growing tumours
• highly malignant glioblastoma multiforme

Each type will have its own issues regarding symptoms and response to treatment, and treatment will depend on its position, its size, its pathological specifications, and its ability to be removed. So, each of these factors will have a bearing on a person’s symptoms, presentation, and the likelihood of having a seizure. Interestingly, it is often those with low grade and benign tumours who are more likely to have a seizure. This is because these types are more likely to interrupt the action of the electricity-generating neurons.

What types of seizures happen to patients with brain tumours?

Many patients who have a brain tumour will present by having a seizure (rather than presenting with a headache as is often thought by many people). Most people believe that a seizure is always a “generalised tonic-clonic seizure”, which is associated with collapsing, a complete loss of consciousness, jerking, frothing at the mouth and turning blue.

However, this is not the case most of the time. Many people actually present with partial seizures with, for instance, the jerking of a limb, an unusual feeling in the tummy, difficulty talking or going blank and carrying out repetitive actions. Very often, it will seem as if the person is having a stroke at presentation with the symptoms reversing after a while.

Nonetheless, it’s important to bear in mind that of all patients who experience a seizure resulting in a visit to the emergency department, only one per cent has seizures caused by a brain tumour.

What can trigger brain tumour-related seizures?

Often, when a person presents with a seizure, it’s because the tumour (which has often been there for some time) has grown to a size that leads to irritation of the neurons, or has produced associated swelling ( oedema).

Seizures can occur and recur for many reasons in patients with brain tumours. It may be that:

• The tumour cannot be completely removed.
• The tumour continues to grow or transform.
• The effect of the cells being “attacked” and start swelling due to  radiotherapy and chemotherapy.
• The effect of surgery and subsequent scar tissue.

Seizures can continue even after a tumour has been completely removed because of the damage done to the surrounding neuronal cells. If someone is already being treated for seizures with a brain tumour, they can recur for any of the above reasons, but also if one forgets to take medication, or due to sleep deprivation or another illness occurring at the same time.

What’s the best way to manage brain tumour-related epilepsy?

Brain tumour-related epilepsy requires a multi-disciplinary approach with the interaction of neurosurgeons, oncologists and neurologists. 

1. There is immediate treatment for someone experiencing a seizure for the first time due to a newly diagnosed tumour. Medication is the first port of call with anti-epileptic medication and if there is swelling, the addition of steroids.
2. If a tumour is operable and the patient is fit, then the next option is for surgery and this will then supply tissue for histology (a study of the microscopic anatomy of tissue) which will guide further treatment. If it is a non-benign lesion, then the oncologists may become involved to provide radiotherapy and/or chemotherapy.
3. Throughout treatment, the neurologist will guide medical treatment with a particular focus on anti-epileptic medications.
4. Often, patients will need to stay on long-term anti-epileptic medications to maintain seizure-freedom, which will need the medication to be regularly adjusted and so will stay under the care of a neurologist, such as myself, for the long-term.

But on the more positive side, many patients go through all the procedures listed above and remain seizure-free. A neurologist, such as myself, can guide them through the process of weaning and withdrawing medication also.

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