Non-convulsive status epilepticus in brain tumors.

Epileptic seizures are very common in brain tumors, depending on histology and tumor site. In low-grade gliomas, it can be the only symptom reaching the 100% of incidence. Pathophysiology is multifactorial and still not perfectly understood. In a high percentage of cases, epilepsy is pharmacoresistant. Surgical resection of tumors can cure it. It happens more easily in low-grade gliomas, with a preoperative epilepsy evaluation, followed by a tailored surgery, not limited to lesionectomy, and including the peritumoral epileptic focus. In high-grade gliomas, postoperative epilepsy recurrence cannot only be due to tumor recurrence, but also to bad pharmacological compliance, or to pharmacoresistance. Seizures may be clustered in a non-convulsive status epilepticus. This condition must be recognized, because it may mimic a neurological worsening due to other reasons, as it presents with confusion, aphasia, and disorientation. EEG monitoring can help recognize the status. The treatment does not differ from that of non-convulsive status, due to other etiologies, but non-inducing AEDs are preferred.