Expert: Claes-Gustaf Nordquist, M.D. - 1/12/2009

Question
I have a 26 yr old with the above brain tumor. It recently has started growing
and she is taking Temador. I have two questions
  1. She is being advised to take a second seizure med besides Keppra
because she has had increased seizures before the Temador was started. She
has had only one round. What seizure meds shouldn't be given with Temador?
   2. We're told her tumor (about 30%) is in the primary motor area (frontal
lobe) and that part they will not operate on. Their thought is without any Tx
she will die in 2 yrs. With all Tx she will have 3-5 yrs. My question is if they
can't get that motor area what will her quality of life be even if they are able
to take the 70% out. How or why would she die if the motor area only
paralyzes?  Or is the assumption or Hx of these tumors in 3-5 yrs they
become a Grade 3 or 4 and then death becomes more imminent? She has not
chosen surgery for this past yr & a half and I'm not sure she will ever choose
surgery so I'm wondering how it will end. She has a AP 6.8cm Rt frontal with
a 5.5cm width. The more recent MRIs only state Rt frontal but at diagnosis in
8/07 they said Rt Parietal as well. The last MRI showing the change stated
Associated mass effect upon the body of the Rt lateral ventricle and slight
displacement of falx to the left side  and then of course fairly extensive Rt
frontal lobe mass. My daughter doesn't like to know these things but I do so
that is why I do my own research for my understanding. I realize she is old
enough to make her own choices.   Thank You, I hope these questions were
clear

Answer
I'm a medical oncologist & radiation therapist with experience of treating brain tumors, not a neurologist or neurosurgeon. So I strongly suggest that you discuss anti epileptic medication with a neurologist or neurosurgeon. Especially since I'm also a Swede living in Sweden and I do not know what is available where you are wherever that may be. I believe that her neurosurgeon is of the opinion that that close to her motor cortex the surgical risks are in any case far to big for any surgery. So only what is at a safe distance may be removed. It seems her tumor is also too big for radiological treatment with the GammaKnife if I have understood your question correctly. The skull is more or less a closed space. So a growing tumor will not only invade its surroundings it will also decrease the available space inside the skull. That will increase the pressure there interfering with the blood supply.That in the end always kills the victim (the tumor commits suicide at the same time for the same reason). If her tumor's grade changes to a higher number during this process it will move faster. I'm sorry I have nothing better to tell you!