Timothy Ryken, MD
Department of Neurosurgery
University of Iowa Hospitals and Clinics

Creation Date: April 2000
Last Review Date: April 2000
Peer Review Status: Internally Peer Reviewed

I had surgery three months ago to remove a tumor on the right side of my brain. Now I am taking tegrotal for seizures. Will exercising cause a seizure?

Of course, any comments I can make are only general suggestions, and you will need to check with your doctor for specifics. However, in my patients, it is very common to utilize tegrotal or other similar medications to prevent seizures. Sometimes indefinitely, depending on how concerned I am with the particular location. I do not generally recommend that my patients stop exercising or participating in exercise related activities. Seizures are often unpredictable, and I believe the benefit of exercise outweighs the potential for increased seizure activity.

Are there any non-surgical treatments to treat brain tumors?

One of the primary roles for surgery in patients with newly recognized lesions of the brain is to confirm a diagnosis. It is relatively uncommon to be able to predict with great accuracy the type of tumor or even whether a tumor is present without at least a tissue diagnosis. What that means is most patients will require at least a biopsy in the majority of cases. In the instances where there is little or no doubt about the identity of a tumor such as in a patient with known breast or lung cancer and a new lesion of the brain, either standard or focused radiation treatments can be considered without surgery. Very infrequently similar approaches could be considered using chemotherapy.

What percentage of brain tumors is cancerous?

When I describe the type of tumors that we see in the brain to patients, I try to give a feeling for two major aspects: First of all, some tumors can be "benign" in terms of their growth potential, but behave very "malignantly" because of their location making them difficult to treat. The other aspect is how fast will these tumors grow despite our best treatments. Brain tumors in general do not tend to spread throughout the body, but are a problem due to their continued growth inside the brain. If you think of the potential for re-growth, approximately 50 to 70 percent of all intercranial tumors will require additional treatment other than surgery alone.

What type of exercise is deemed potential?

In terms of general activities, as I mentioned I don't specifically restrict patients from their usual activities. Patients who have a tendency towards seizures with any specific activity in a repetitive manner should strongly consider stopping those activities.

Can you tell me some things about Tegretol and its effectiveness?

The FDA has recently approved Tegretol for selected patients who have failed other therapies for anaplastic astrocytoma. There is preliminary evidence that this medication improves survival in this patient group. The University of Iowa at this point has not been involved extensively in these studies, but I can say that the evidence is strong enough for the FDA to have taken action. We, at the University, are investigating Tegretol in conjunction with a variety of other treatments. Although these studies have been encouraging, unfortunately they are a long way from providing a cure for these aggressive tumors.

What are some general symptoms and signs of concern for a brain tumor?

With modern medical imaging, many brain tumors are being identified before patients develop anything but very mild symptoms such as new or unusually prolonged headaches. Classically, brain tumors present with symptoms related to their location similar to patients who present with strokes. For example, a patient presenting with gradual left sided weakness of the arm or leg could be at risk for having a right-sided brain tumor. A common presentation particularly in younger patients is the new onset of seizures. Other common symptoms include nausea, vomiting, double vision, increasing drowsiness.

Who is most at risk for a brain tumor?

Brain tumors occur in all age groups. Therefore, we all carry some risk for developing a tumor at any age. The very young, meaning less than 2 years old, and the elderly are at particular risk for having tumors, which will significantly shorten their life. Interestingly, the types of tumors seen in the different age groups vary substantially. For example, the high-grade malignant glioblastoma is the most prevalent in the elderly while the medulloblastoma is most prevalent in infants. Both tumors can be life threatening, but behave very differently clinically.

I have very bad headaches. I see a neurologist, he gave me some medication, amitriptyline, for the pains. Is this a good medication for headache?

Amitripyline or Elavil has been a very good medicine for doctors attempting to help patients with chronic pain, including headaches. If headaches or other pain symptoms persist, a variety of medications can be attempted. It is often very difficult to predict which will work the best for any one individual. However, amitriptyline is a good choice in many cases because it is not a narcotic medication.

I was taking Imitrex but that had me sick of the stomach whenever I take them.

Imitrex is used for migraine headaches, not for headaches due to brain tumors. Headache management can be very challenging. Headaches are a small portion of the difficulties encountered in treating brain tumors. Obviously, the more concerning portion of the treatment is focused on preserving neurologic function.

What is a typical brain tumor surgery?

There are two main purposes for surgery in patients with brain tumors. The first is to obtain tissue to make a diagnosis. In some cases, tumors can be treated with minimal amounts of surgery. The second goal is to allow the surgeon access to the tumor to attempt total removal. In some cases, this cannot be achieved but reducing the total volume of the tumor will assist with radiation treatments or chemotherapy in treating the tumor. From a technical standpoint, a brain tumor removal operation is called a craniotomy. This involves an incision in the skin an opening in the bone of the skull with temporary removal of a portion of the bone to allow access to the tumor. The bone is typically replaced at the conclusion of the operation.

What about computerized brain surgery? Are you familiar with this?

I believe what you may be referring to is called Image Guided Surgery and is being used increasingly by surgeons in many areas of the body. For the neurosurgeon performing brain tumor operations, this involves placing some markers on the scalp, obtaining a pre-operative CT or MRI image of the brain, and then processing this information in a computer workstation pre-operatively. What this allows the surgeon to do is to study the patient's anatomy in a three dimensional computer model before entering the operating room. Many types of anatomical information can be entered into the computerized image to further refine and plan the operative approach to a brain tumor. Once the operation is underway, this same system can be used to help the surgeon identify the location of the tumor during the operation and help to ensure that the approach to the tumor is as safe as possible.

Is it true that there is a new treatment for brain tumors involving scorpion venom?

My research has not dealt with this issue, but I am aware of some interesting work by labs both in the U.S. and in France who have identified a chemical in scorpion venom which appears to have selective toxicity for brain tumor cells based on its ability to block molecules moving in and out of these malignant cells. To the best of my knowledge, these studies are very preliminary, but, given the dismal outlooks for many of our malignant brain tumor patients, we encourage all efforts in this regard.

I've read about a gamma knife machine. Is this used for brain tumors?

The gamma knife is a technique of focusing radiation in a very accurate manner. In some cases when brain tumors are small and localized, this may be an excellent option. Most doctors using the gamma knife or other forms of stereotactic radiation will still require a tissue diagnosis before treatment. So it will not completely replace open surgery at this time. It has been also used in a number of other clinical situations and experimental settings. This includes chronic pain and degenerative neurologic conditions such as Parkinson's disease. In many cases, malignant brain tumors have already spread beyond the limits of the gamma knife. Most surgeons feel that three centimeters in diameter is the maximum size the gamma knife can be used for. Nonetheless, it is a valuable addition to the treatment possibilities for brain tumors.