Beyin Tümörleri ve Epilepsi
Özet
Beyin tümörleri, epilepsinin en sık nedenlerinden biri olup, nöbetler hastaların yaklaşık %40'ında başlangıç semptomu olarak ortaya çıkar. Dünya Sağlık Örgütü sınıflamasına göre yavaş büyüyen düşük dereceli tümörler (Grade 1 ve 2 gliomalar, DNET, ganglioglioma) kortekse yakın yerleşimleri nedeniyle yüksek dereceli malign tümörlere (GBM) kıyasla daha sık epileptik nöbetlere yol açar. Tümör ilişkili epileptogenez mekanizması tam olarak açıklanamamakla birlikte; tümörün salgıladığı kimyasal moleküller, çevre dokuya bası sonucu oluşan iskemi ve hipoksi, hücresel/metabolik değişimler (glutamat artışı, GABAerjik azalma), kan-beyin bariyeri bozuklukları ve genetik varyasyonlar (LGI1 geni, 19q delesyonu) gibi çok faktörlü nedenlere dayanmaktadır. Klinik olarak temporal lob yerleşimli tümörler daha dirençli epileptik nöbetlere neden olurken, cerrahi rezeksiyon nöbet kontrolünde en etkili yöntemdir; radikal tümör eksizyonu ve peritümöral dokunun çıkartılması nöbet sıklığını önemli ölçüde azaltarak yaşam kalitesini artırır. Antiepileptik ilaç tedavisinde ise yan etkilerinin azlığı nedeniyle yeni nesil ilaçların profilaktik kullanımı tercih edilmektedir.
Brain tumors are among the most common causes of epilepsy, with seizures presenting as the initial symptom in approximately 40% of patients. According to the World Health Organization classification, slow-growing, low-grade tumors (Grade 1 and 2 gliomas, DNET, ganglioglioma) cause epileptic seizures more frequently than high-grade malignant tumors (GBM) due to their proximity to the cortex. Although the mechanism of tumor-associated epileptogenesis is not fully elucidated, it relies on multifactorial causes such as chemical molecules secreted by the tumor, ischemia and hypoxia resulting from mass effect on surrounding tissues, cellular/metabolic alterations (increased glutamate, decreased GABAergic neurotransmission), blood-brain barrier disruptions, and genetic variations (LGI1 gene, 19q deletion). Clinically, tumors localized in the temporal lobe cause more refractory seizures, and surgical resection remains the most effective method for seizure control; radical tumor excision and removal of peritumoral tissue significantly reduce seizure frequency and improve quality of life. Regarding antiepileptic drug therapy, the prophylactic use of new-generation drugs is preferred due to their lower side-effect profiles.
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