Abstract
<jats:p>Tumor-related epilepsy (TRE) is a common and clinically significant manifestation in patients with central nervous system neoplasms. Seizures are observed in approximately 30% of patients, serving as the initial symptom in 30–50% of cases, while 10–30% develop seizures during disease progression. The risk and clinical features of TRE depend on tumor histology and anatomical location. Low-grade tumors, such as dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas, demonstrate the highest epileptogenic potential. In contrast, high-grade gliomas, including glioblastomas, are associated with lower, yet still considerable, seizure rates. The pathophysiological mechanisms underlying TRE involve a multifaceted interaction among tumor biology, the peritumoral microenvironment, neurotransmitter imbalances, neuroinflammation, and genetic and molecular alterations. These elements collectively contribute to neuronal hyperexcitability and seizure generation. Effective management necessitates an individualized, multidisciplinary approach that integrates both pharmacological and surgical strategies. Second-generation antiseizure medications, including levetiracetam, lamotrigine, and lacosamide, are preferred because of their efficacy, tolerability, and reduced potential for drug interactions with oncological treatments. Surgical resection, encompassing both tumor removal and targeted excision of epileptogenic zones, remains the most effective intervention for seizure control. Intraoperative electrocorticography (IoECoG) and stereoelectroencephalography (SEEG) enable precise mapping and facilitate tailored resections. Additionally, emerging therapies such as laser ablation and neuromodulation represent promising adjunctive options. In summary, TRE constitutes a multifaceted clinical condition that requires thorough diagnostic assessment and coordinated therapeutic approaches to enhance seizure control, facilitate effective tumor management, and maintain neurological function and quality of life.</jats:p>