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This chapter discusses the etiology, diagnosis, and principles of management of epilepsy in patients diagnosed with meningiomas. It presents cases that demonstrate the broad spectrum of meningioma-related epileptogenesis and the challenges associated with their surgical management. In terms of the medical management of epilepsy related to meningiomas, the choice of antiepileptic drugs (AEDs) depends on various factors including age, drug-drug interactions, and comorbid conditions. Meningiomas along the convexities are often readily accessible and so surgical resection is often indicated for treatment of the underlying neoplasm. When cortical tissue is involved and cortical resection is anticipated, intraoperative electrocorticography (ECoG) may be performed to define the interictal irritative zone. Careful surgical technique during the initial tumor resection may help to prevent some of these cases, but when seizures occur or persist after surgery, and are not controlled by AEDs, the patient should be considered for further surgery to control the epilepsy.
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