Ebook Current clinical neurology (3/E): Part 2
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Ebook Current clinical neurology (3/E): Part 2
Brain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2tumors are frequently associated with seizures and epilepsy.In the intensive care unit (1CU). three categories of patients with brain tumors may be brought to the intensivist's attention related to seizures. (I) Some of these patients, especially if the seizures recur or are associated with signific Ebook Current clinical neurology (3/E): Part 2ant cerebral edema, hemorrhage, signs of increased intracranial pressure, or pending herniation, will end up being admitted to the ICU and spend anywhEbook Current clinical neurology (3/E): Part 2
ere from one day to feu days of monitoring. In all these cases, the members of the 1CU team will be the first ones to address at least the acute, shorBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2n the ICU for observation. These patients may have no history of seizures or may have exhibited one or more seizures in the ICU. and appropriate treatment should be presenbed. Therefore, an important issue to be addressed in the postoperative period, if patients are seizure-free, is whether they nee Ebook Current clinical neurology (3/E): Part 2d prophylactic antiepileptic drug (AEDj treatment during their ICU or hospital stay. (3) The third category includes patients with known and already tEbook Current clinical neurology (3/E): Part 2
reated brain tumors, who are admittedP.N. VarelasEbook Current clinical neurology (3/E): Part 2
stoperative issues. In this retrospective study, only 23/158 (15%) postoperative tumor patients had a >24 h stay in the NICU at the Johns Hopkins HospBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2umor location, mass effect, and midline shift), an intraoperative fluid score (comprising estimated blood loss, total volume of crystalloid, and other colloidi'hypertonic solutions administered), and postoperative intubation. Seizures were preoperatively present in 15/158 (9.5%) patients. Five patie Ebook Current clinical neurology (3/E): Part 2nts (3.2%) had postoperative seizures. More patients who stayed longer had seizures postoperatively (2/135 patients in group 1 [<24 h NICU stay I vs 3Ebook Current clinical neurology (3/E): Part 2
/23 patients in group 2 [>24 11 NICU stay], odds. 95% CI. 10. 1.6-62.5. p = 0.02). NICU resource use was reviewed in detail for 134 of 135 patients whBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2tration, but this was never done after the first 16 postoperative hours. This study provides valuable information regarding incidence of ICU seizures in brain tumor patients and use of 1CU resources to treat them, but the results cannot be necessarily generalized to other ICUs.A more recent study of Ebook Current clinical neurology (3/E): Part 2 105 pediatric patients admitted to a pediatric ICU after brain tumor resection showed that the majority (69.5%) stayed there for <1 day. The presenceEbook Current clinical neurology (3/E): Part 2
of preoperative seizures was more common in the <1 day group, with 25 (34%) patients reporting seizures compared to 3 (9%) in the >1 -day group. ElevBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2r PICU stay [2].© Springer International Publishing AG 2017P.N. Varelas. J. Claassen (eds.). Seizures in C/ilu al Care. Current Clinical Neurology. DOI 10.1007.978-3-319-49557-6_ 12211P.N. Varelas et aL212IncidenceOverall, the incidence of brain tumors is 4% in patients with epilepsy (3|. Conversely Ebook Current clinical neurology (3/E): Part 2. seizure occurrence remains a major morbidity problem in patients with intracranial tumors. Between 30 and 50% of patients with brain Illinois presenEbook Current clinical neurology (3/E): Part 2
t w itli seizures, and an additional 30% w ill later dev elop seizures |3|. Between one third and more than half of patients with brain tumors presentBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2% confidence interval 24.7 40.3) to be present at diagnosis [5]. Approximately 30-70% of patients with primary brain tumors will have seizures ar some point throughout their disease [6-9|. Similarly, about 40% of all patients with metastatic brain tumors will have a seizure during their disease [ 10 Ebook Current clinical neurology (3/E): Part 2. 11], Half of these sei zures will be simple or partial complex seizures and tlie other half secondary generalized seizures 112-111. Brain tumors areEbook Current clinical neurology (3/E): Part 2
rarely associated with primary generalized seizures.SE. either convulsive or nonconvulsive. can also occur in patients with brain tumors. Overall. SEBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2 of SE over a 7-year period. Fifty patients had a concurrent diagnosis of cancer. 28 (5% ) of w hom had SE related to the tumor or treatment 116|. In another study. 10.5% of patients with newly diagnosed glioblastoma multiforme and initial postsurgery seizures presented in SE. Two cases of nonconvul Ebook Current clinical neurology (3/E): Part 2sive SE were noted in patients who had been weaned off AEDs from the time of surgery, and two cases of convulsive SE were observed in patients that haEbook Current clinical neurology (3/E): Part 2
d never been treated with AEDs [17],Among the primary brain tumors, the highest incidence of seizures is found in patients with low-grade gliomas (65-Brain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2sembryoplastic neuioecto dermal tumors (ONET. 100%. at an average age of 15 years) |3. 19|. High-grade IV tumors (glioblastomas) have an incidence of about 30-62% (average age at presentation 60 years), in about two thirds at presentation and in one third developing during the course of the disease Ebook Current clinical neurology (3/E): Part 2[3. 6. 20]. In a recent systematic review of meningiomas, preopcrative seizures were observed in 29.2% of 4709 patients with supratentorial meningiomaEbook Current clinical neurology (3/E): Part 2
s and were significantly predicted by male sex. absence of headache, periluinoral edema, and non skull base location. After Surgery, seizure freedom wBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2uals without preoperative epilepsy who underwent resection, new postoperative seizures were seen in 12.3%. of patients (21|.Other studies have estimated the incidence of seizures with metastatic tumors at 35% 122-241. Melanoma, choriocarcinoma. lung cancer, and breast cancer are tumors frequently me Ebook Current clinical neurology (3/E): Part 2tastasizing to the brain and associated with hemorrhage and seizures. Among metastatic tumors, mela noma seems to have the highest incidence of seizurEbook Current clinical neurology (3/E): Part 2
es.Conversely, based on a study from the Cleveland Clinic, among patients with intractable chronic epilepsy, the most common types of tumors discovereBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2 oligodendroglioma were also tumors frequently associated with epilepsy. As already mentioned, it seems likely that low grade, well differentiated gliomas have higher incidence of seizures than more aggressive glioblastomas or anaplastic astrocytomas |3, 26|. A similar distinction may be true for ag Ebook Current clinical neurology (3/E): Part 2e: children have low-grade tumors and epi lepsy as llie primary , if only. sign, compared to middle-aged or elderly adults who have higher-grade tumorEbook Current clinical neurology (3/E): Part 2
s and more neurological focality |3|.Different brain areas are also characterized by varying susceptibility to seizures. For example, among patients wBrain Tumors and Critical Care SeizuresPanayiotis N. Varelas, Jose Ignacio Suarez, and Marianna V. spanaki12IntroductionPrimary ami metastatic brain t Ebook Current clinical neurology (3/E): Part 2-statistic image showing the aggregate location of 124 tumors, Lee et al. demonstrated that smaller tumors, those growing less quickly and those located in the superficial cortical areas, especially temporal or frontal lobes or the insula, have a higher incidence of seizures [28]. Similar observatio Ebook Current clinical neurology (3/E): Part 2ns suggest that the limbic and temporal lobe, primary and supplementary’ motor(M-l. M-ll) areas, and primary and secondary somatosensory (S-I. S-ll opEbook Current clinical neurology (3/E): Part 2
ercula and insula) areas have the lowest thresholds for seizures |26], In contrast, the occipital lobe has a much higher threshold [29] Tumors in theGọi ngay
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