Neurological problems in advanced cancer

This chapter covers the common neurological symptoms encountered in patients with advanced malignancy such as seizures, local and central nerve damage, and paraneoplastic neurological syndromes. Non-convulsive status epilepticus (NCSE) is a possible cause of confusion or delirium in terminally ill patients. The clinical presentation varies from altered mental status to comatose patients, without visible convulsions. In comatose patients, unilateral tonic head and eye movement is often observed. Other symptoms include myoclonic contractions of the angle of the mouth, mild clonus of an extremity, or, rarely, epileptic nystagmus. EEG is the most important diagnostic tool to identify epileptiform activity. Treatment should be initiated following a stepwise model (e.g. phenytoin, sodium valproate, levetiracetam, together with benzodiazepines), avoid intubation, and transfer to the intensive care unit. Although mortality rates are high, in some patients NCSE can be reversed by treatment.