Glioma-associated epilepsy: toward mechanism-based treatment

Epilepsy is common in glioma patients, and glioma-related epilepsy has a strong impact on patients’ quality of life. Glioma-related epilepsy has a unfavorable clinical course when compared to other types of symptomatic epilepsy, with low rates of seizure freedom, common relapses of seizures after seizure-free periods, and a severe outcome in case of intractable seizures (status epilepticus). Translational research is starting to elucidate the specific pathophysiological mechanisms in this disease: the molecular-biological characteristics of the tumor result in metabolic changes in the glioma and the peritumoral region. These changes lead to abnormal neuronal and non-neuronal signaling changes in the tumor’s surroundings and in the brain’s global functional network (“connectome”). Anti-neoplastic treatments often cause amelioration of epilepsy, possibly by reverting the pathophysiological pro-epileptogenic processes in the tumor. Further research should focus on these pathophysiological mechanisms and on the possibilities for new mechanism-based anti-epileptic treatments. Clinical trials for gliomas should incorporated epilepsy as an outcome measure.