Russian Journal of OncologyRussian Journal of OncologyРоссийский онкологический журнал1028-99842412-9119Eco-Vector69624110.17816/onco696241TOKDRSReviewsНаучные обзорыReview ArticleModern approaches to the management of brain tumor–related epilepsy: a reviewСовременные методы управления эпилепсией, связанной с опухолями головного мозга: обзор литературыhttps://orcid.org/0000-0002-1533-71543362-5230NazarovAnvar F.НазаровАнвар Фаритович
Russian Federation
krios.gip.14@mail.ruhttps://orcid.org/0009-0008-8863-9867GanievGazinur R.ГаниевГазинур Рамилевич
Russian Federation
gazganiev@mail.ruhttps://orcid.org/0009-0007-3644-9028PopovaDarya L.ПоповаДарья Леонидовна
Russian Federation
popovna.d27@gmail.comhttps://orcid.org/0009-0007-3919-661XMagaramovaAlbina T.МагарамоваАльбина Таджидиновна
Russian Federation
magaramova.albina@icloud.comhttps://orcid.org/0009-0007-3257-9343MasnenkoYaroslav D.МасненкоЯрослав Дмитриевич
Russian Federation
ymasnenko14@mail.ruhttps://orcid.org/0009-0006-9066-0169PimenovDmitrii S.ПименовДмитрий Станиславович
Russian Federation
dimpimenoff@yandex.ruhttps://orcid.org/0009-0007-7993-7558GammadaevaKhadizha Sh.ГаммадаеваХадижа Шихамировна
Russian Federation
hadizagammadaeva@gmail.comhttps://orcid.org/0009-0009-0532-0568SurakmatovNursultan B.СуракматовНурсултан Бакытбекович
Russian Federation
n.surakmatov@yandex.ruhttps://orcid.org/0009-0001-3528-3552AbdrakhmanovaRaziliya R.АбдрахмановаРазиля Робертовна
Russian Federation
robertovna.02@mail.ruhttps://orcid.org/0009-0004-4047-8890KhafizovaAntonina S.ХафизоваАнтонина Сергеевна
Russian Federation
tonya.aksenova.03@mail.ruhttps://orcid.org/0009-0002-2785-0497RemikhanovaKhаnum A.РемихановаХанум Арифовна
Russian Federation
xanxam2003@gmail.comhttps://orcid.org/0009-0006-6544-1183BaisovaAmina A.БаисоваАмина Аслановна
Russian Federation
aminabaisovaaa@mail.ruhttps://orcid.org/0009-0009-5408-9470TsytsiuraPetr M.ЦыцюраПётр Максимович
Russian Federation
tsytsiura.peter@yandex.ruBashkir State Medical UniversityБашкирский государственный медицинский университетKazan State Medical UniversityКазанский государственный медицинский университетDagestan State Medical UniversityДагестанский государственный медицинский университетPerm State Medical University named after Academician E.A. VagnerПермский государственный медицинский университет им. академика Е.А. ВагнераPirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаPatrice Lumumba Peoples’ Friendship UniversityРоссийский университет дружбы народов имени Патриса Лумумбы13012026140220263043383531411202528122025Copyright ©; 2025, Eco-VectorCopyright ©; 2025, Эко-Вектор2025Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://rjonco.com/1028-9984/article/view/696241

This review provides a comprehensive analysis of current strategies for the diagnosis, management, and treatment of brain tumor–related epilepsy. Epileptic seizures are a frequent complication of intracranial neoplasms, substantially impairing patients’ quality of life and imposing a substantial economic burden on healthcare systems. This review provides a detailed examination of the current concepts of brain tumor–related epilepsy pathogenesis, which are based on active interactions between tumor cells and neuronal networks of the brain. Particular attention is paid to the pivotal role of molecular mechanisms, including mutations in the IDH1 and PIK3CA genes, which represent a shared link between oncogenesis and epileptogenesis. Modern diagnostic methods are reviewed, and the potential of a multimodal approach is analyzed, including standardized neuroimaging techniques (e.g., magnetic resonance imaging, positron emission tomography), prolonged video electroencephalogram monitoring with assessment of rhythmic and periodic activity patterns in the brain, as well as intraoperative electrocorticography used to determine the boundaries of the epileptogenic zone. The main emphasis of the review is on the comprehensive management of brain tumor–related epilepsy. Maximal, and ideally supramarginal, tumor resection is shown to be the most effective method for achieving epileptic seizure control. With regard to pharmacotherapy of brain tumor–related epilepsy, levetiracetam is currently considered the first-line antiepileptic drug due to its high efficacy and favorable tolerability profile. In cases of drug therapy resistance, agents (perampanel, ivosidenib) targeting specific molecular tumor pathways and neuromodulation techniques (deep brain stimulation and responsive neurostimulation) have demonstrated substantial therapeutic benefit. The antiepileptic potential of adjuvant chemotherapy and radiotherapy is also considered. In conclusion, it is highlighted that contemporary management of brain tumor–related epilepsy requires a personalized approach integrating the described therapeutic methods, taking into account the shared molecular mechanisms of oncogenesis and epileptogenesis. Despite substantial therapeutic advances in brain tumor–related epilepsy therapy, there remains a clear need for standardized management protocols and large randomized clinical trials to further optimize treatment strategies.

Настоящий обзор литературы посвящён комплексному анализу современных стратегий диагностики, ведения и лечения опухолеассоциированной эпилепсии (ОАЭ). Эпилептические приступы (ЭП) являются частым осложнением внутричерепных новообразований, оказывающим негативное влияние на качество жизни пациентов и создающим экономическое бремя для системы здравоохранения. В данной работе детально рассмотрены современные представления о патогенезе ОАЭ, которые подразумевают активное взаимодействие между опухолевыми клетками и нейронными сетями головного мозга (ГМ). Отдельное внимание уделяется ключевой роли молекулярных механизмов, в частности мутаций в генах IDH1 и PIK3CA, которые являются общим звеном онкогенеза и эпилептогенеза. Рассмотрены современные методы диагностики, а также проанализированы возможности мультимодального подхода, включающего стандартизированные методы нейровизуализации (МРТ, ПЭТ), продолжительный видео-ЭЭГ-мониторинг с оценкой ритмических и периодических паттернов нервных импульсов в ГМ, а также интраоперационную электрокортикографию, применяемые для определения границ эпилептогенной зоны. Основной акцент сделан на комплексном лечении ОАЭ. Показано, что максимально радикальная, а в идеале супрамаргинальная, резекция опухоли является наиболее эффективным методом достижения контроля над ЭП. Касательно фармакотерапии ОАЭ препаратом первого выбора на сегодняшний день является леветирацетам, обладающий высокой эффективностью и благоприятным профилем переносимости. При фармакорезистентных формах наиболее эффективны таргетные препараты (перампанел, ивосидениб), воздействующие на специфические молекулярные мишени опухоли, а также методы нейростимуляции (глубокая стимуляция мозга, реагирующая нейростимуляция), показавшие свою высокую эффективность. Отмечен противоэпилептический потенциал адъювантной химио- и лучевой терапии. В заключение подчёркивается, что современное управление ОАЭ требует персонализированного подхода, интегрирующего описанные методы терапии с учётом понимания общих молекулярных механизмов онко- и эпилептогенеза. Несмотря на значительный прогресс в области терапии ОАЭ, сохраняется необходимость в стандартизации протоколов ведения пациентов и проведении крупных рандомизированных исследований для дальнейшей оптимизации терапевтических стратегий.

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