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Ependymoma Medication

  • Author: Jeffrey N Bruce, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
 
Updated: Apr 14, 2015
 

Medication Summary

No specific medications exist to treat ependymomas; however, supratentorial ependymomas require medical treatment. For seizures, the patient is usually started on levetiracetam (Keppra), phenytoin (Dilantin), or carbamazepine (Tegretol). Levetiracetam is often used because it lacks the effects on the P450 system seen with phenytoin and carbamazepine, which can interfere with antineoplastic therapy. Vasogenic cerebral edema is treated with corticosteroids (eg, dexamethasone), generally in combination with an anti-ulcer agent. Corticosteroids also are effective to treat edema associated with intramedullary tumors in the preoperative and postoperative settings.

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Anticonvulsants

Class Summary

These agents are used to treat and to prevent seizures.

Levetiracetam (Keppra)

 

Used as adjunct therapy for partial seizures and myoclonic seizures. Also indicated for primary generalized tonic-clonic seizures. Mechanism of action is unknown.

Phenytoin (Dilantin)

 

Blocks sodium channels and prevents repetitive firing of action potentials. Effective anticonvulsant and first-line agent in treating partial and generalized tonic-clonic seizures.

Carbamazepine (Tegretol)

 

Like phenytoin, interacts with sodium channels and blocks repetitive neuronal firing. First-line agent to treat partial seizures and may be used for tonic-clonic seizures as well. Extended release form available, which is administered bid. Serum drug levels should be monitored (ideal range is 4-8 mcg/mL).

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Corticosteroids

Class Summary

These agents reduce peritumoral edema, frequently leading to symptomatic and objective improvement.

Dexamethasone (Decadron)

 

Postulated mechanisms of action in brain tumors include reduction in vascular permeability, cytotoxic effects on tumors, inhibition of tumor formation, and decreased CSF production.

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Contributor Information and Disclosures
Author

Jeffrey N Bruce, MD Edgar M Housepian Professor of Neurological Surgery Research, Vice-Chairman and Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons

Jeffrey N Bruce, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Neurological Surgeons, New York Academy of Sciences, North American Skull Base Society, Society of Neurological Surgeons, Society for Neuro-Oncology, American Society of Clinical Oncology, Congress of Neurological Surgeons, Pituitary Society

Disclosure: Received grant/research funds from NIH for other.

Coauthor(s)

Neil A Feldstein, MD Director of Pediatric Neurosurgery, Department of Neurosurgery, Babies and Children's Hospital of New York, Assistant Professor,Departments of Clinical Neurosurgery and Pediatrics, Columbia-Presbyterian Medical Center, Columbia University

Neil A Feldstein, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Cleft Palate-Craniofacial Association, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

David J Fusco, MD Associate Neurosurgeon, Barrow Neurosurgical Associates

David J Fusco, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, North American Spine Society, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Benjamin Kennedy, MD Columbia University College of Physicians and Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Robert C Shepard, MD, FACP Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for Physician Leadership, European Society for Medical Oncology, Association of Clinical Research Professionals, American Federation for Clinical Research, Eastern Cooperative Oncology Group, Society for Immunotherapy of Cancer, American Medical Informatics Association, American College of Physicians, American Federation for Medical Research, American Medical Association, American Society of Hematology, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

We wish to acknowledge previous contributions to this article by Paul C McCormick, MD, and Allen Waziri, MD.

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CT scan without contrast. Fourth ventricle ependymoma.
CT scan without contrast. Fourth ventricle ependymoma. Note blood in the fourth ventricle.
CT scan without contrast in the patient with fourth ventricle ependymoma. Blood has refluxed into the third and lateral ventricles.
CT scan without contrast in the patient with fourth ventricle ependymoma. Note blood traversing foramina.
T1-weighted MRI. Rare case of a fourth ventricle ependymoma presenting as an intraventricular bleed.
T1-weighted MRI without contrast demonstrating ependymoma located in the fourth ventricle.
T2-weighted MRI demonstrating ependymoma in the fourth ventricle.
Coronal T1-weighted MRI with contrast demonstrating ependymoma of the fourth ventricle.
Gross surgical specimen of a fourth ventricle ependymoma.
Histologic study of a classic ependymoma. Note the characteristic perivascular pseudorosettes.
Cellular ependymoma. Cells with a high nuclear-cytoplasmic ratio. Few pseudorosettes or paucicellular areas are present.
Myxopapillary ependymoma. Clusters of loosely arranged cuboidal cells separated by pools of mucin.
Clear cell ependymoma. Round cells with cytoplasmic clearing. This may mimic an oligodendroglioma.
 
 
 
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