CLINICAL STUDY Epilepsy in the end-of-life phase in patients with high-grade gliomas Andrea Pace • Veronica Villani • Cherubino Di Lorenzo • Lara Guariglia • Marta Maschio • Alfredo Pompili • Carmine Maria Carapella Received: 5 June 2012 / Accepted: 10 October 2012 Ó Springer Science+Business Media New York 2012 Abstract Epilepsy is common in patients with brain tumors. Patients presenting seizures as the first sign of a malignant glioma are at increased risk of recurrent seizures despite treatment with antiepileptic drugs. However, little is known about the incidence of epilepsy in the last stage of disease and in the end–of-life phase of brain tumor patients. We retrospectively analyzed the incidence of seizures in the last months of life in a series of patients affected by high-grade gliomas who were assisted at home during the whole course of the disease until death. A total of 157 patients were available for analysis. Of these patients, 58 (36.9 %) presented seizures in the last month before death. The risk of seizures in the end-of-life phase is higher in patients presenting previous history of epilepsy, particularly in patients with late-onset epilepsy. Out of the 58 patients presenting seizures in the last month of life, 86.2 % had previously had seizures and 13.8 % were sei- zure free. Most patients may encounter swallowing diffi- culties in taking anticonvulsants orally due to dysphagia and disturbances of consciousness, thus anticonvulsant treatment needs to be modified in advance. Loss of seizure control in the end-of-life phase may influence the quality of life of patients and their caregivers. Keywords Brain tumor Á Epilepsy Á End of life Á High-grade gliomas Á Anticonvulsant drugs Introduction Epilepsy is common in patients with brain tumors (BT), with more than one-third of cases with primary brain tumors presenting epileptic seizures during the course of disease [1–3]. Seizures may represent the symptom leading to diagnosis of glioma, but they may also appear at glioma recurrence or during disease progression [4–7]. The fre- quency of epilepsy in patients with BT is 30 % or more depending on tumor type [1, 2]. For 30–50 % of patients with BT, an epileptic seizure is the presenting clinical sign of a tumor; 10–30 % will develop seizures later on in the course of disease [4, 8]. Several factors affect epilepto- genesis in patients with BT, including tumor histology, tumor location, changes in peritumoral environment, and genetic factors [5, 6, 8–11]. Low-grade gliomas (LGG) are the most epileptogenic, and seizure occurrence is reported in 60–88 % of patients. The frequency of seizures in high- grade glioma is lower (30–50 % in glioblastoma). Epilepsy may occur at the onset of disease or in the follow-up phase (late-onset seizures) [4]. In patients without seizures at the onset of disease, the probability of developing epilepsy is reported to be relatively low [6, 12]. Patients with malignant glioma, who commonly present with seizures as the first sign, are at increased risk of recurrent seizures [4]. Recurrent seizures are frequent (50–75 %) in patients A. Pace Á V. Villani Á C. Di Lorenzo Á L. Guariglia Á M. Maschio Á A. Pompili Á C. M. Carapella Palliative Home Care Unit for Brain Tumor Patients, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy A. Pace (&) Neuro-Oncology Unit, Regina Elena Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy e-mail: pace@ifo.it V. Villani Department of Neurology and Psychiatry, University Sapienza, Viale dell’Universita ` 30, Rome, Italy C. Di Lorenzo Carlo Gnocchi Onlus Foundation, Milan, Italy 123 J Neurooncol DOI 10.1007/s11060-012-0993-2