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Epilepsy due to Traumatic Brain Injury, Cerebrovascular Disease, Central Nervous System Infections, and Brain Tumours 

Epilepsy due to Traumatic Brain Injury, Cerebrovascular Disease, Central Nervous System Infections, and Brain Tumours
Chapter:
Epilepsy due to Traumatic Brain Injury, Cerebrovascular Disease, Central Nervous System Infections, and Brain Tumours
Author(s):

Gagandeep Singh

, J.M.K. Murthy

, and Ashalatha Radhakrishnan

DOI:
10.1093/med/9780199659043.003.0020
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date: 26 June 2022

Traumatic brain injury (TBI), cerebrovascular diseases (CVD), central nervous system (CNS) infections and brain tumours combined all account for roughly one-fifth of the aetiologies of newly-diagnosed epilepsies. The risk of epilepsy associated with each of these conditions is variable and depends on a number of factors. For both TBI and stroke, the most important determinants are location and severity of the injury or stroke. Among various CNS infections, episodes of viral encephalitis are associated with the highest risk of epilepsy and among various brain tumours, the low grade glial neoplasms, including developmental tumours such as dysembroplastic neuroepithelial tumours (DNETs) and gangliogliomas are most frequently associated with chronic epilepsy. One important consideration in the treatment of epilepsy associated with each of these conditions is the range of drug interactions between AEDs and drugs used to treat either the primary condition (e.g. tumour with cancer chemotherapeutic agents) or its associated comorbidities (e.g. in CVD). The newer AEDs (e.g. levetiracetam) offer the promise of being devoid of any known drug interactions and experience appears to be accumulating regarding their use in various situations associated with each condition. It is clear that primary prevention of seizures with the first-line AEDs has practically no role in the management these conditions (including TBI, stroke, infections, and tumours). The prognosis of epilepsy associated with stroke is generally good and that following TBI and CNS infections is variable. There is a high chance of developing medically-refractory epilepsy with low-grade glial brain tumours. Surgery has a role in the management of medically-refractory epilepsy associated with TBI and CNS infections but there are caveats to a wider application. In low grade glial neoplasms, surgical treatment is of critical importance in ensuring seizure remission.

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