General Medical Therapy

Corticosteroids provide symptomatic improvement in most patients with increased intracranial pressure from edema. The effects of corticosteroids appear within 24 to 48 hours after the initial administration and usually peak at 1 week. Steroids produce a significant reduction in brain tumor volume and an even greater reduction in peritumoral edema, but they are not without pitfalls. The side effects of long-term glucocorticoids are well known and have the potential to cause disability greater than that produced by the tumor itself, particularly in the form of insomnia, steroid-induced (proximal) myopathy, facial adiposity, osteoporotic compression fractures, and non-dose-related risk of aseptic necrosis of the hip.25

Mannitol given as a bolus (0.25 to 1 g/kg every 4 to 6 hours) can acutely reduce symptoms associated with peritu-moral edema. Unless followed by surgical debulking or successful cytotoxic therapy, its maximum length of benefit is usually measured in weeks. In general, the management of low-grade invasive gliomas is controversial, because the natural history of these lesions might include long periods of clinical


Seizures are prevalent in patients with glioma, particularly in slowly growing, low-grade gliomas, and require adequate management. Clinicians should recognize the possibility that seizures could be caused by hyponatremia, hypoglycemia, and hypocalcemia, as well as by mass effect. Seizures are generally managed with standard anticonvulsants, including phenytoin, phenobarbital, primidone, gabapentin, lamotrigine, carba-mazepine, valproic acid, and clonazepam. Anticonvulsants, which are generally dose dependent, can interact with drugs that are commonly given to patients with brain tumors to produce adverse effects, some of which are drowsiness, dizziness, ataxia, nausea, vomiting, confusion, constipation, tremor, hypersalivation, and blurred vision.

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