Antiepileptic Drug Management in Brain Tumor Patients

Epileptic seizures affect up to half of all individuals with primary or metastatic brain tumours and constitute a major determinant of quality of life, neurological function and overall prognosis. Tumour-related epilepsy arises from a complex interplay between peritumoral inflammation, altered neurotransmitter balance (notably excess glutamate and reduced GABAergic inhibition) and tumour-specific metabolic derangements such as oncometabolite accumulation in IDH-mutant gliomas. Management aims to achieve seizure freedom while preserving cognitive function and avoiding interference with oncological therapies. Current consensus discourages routine prophylactic antiepileptic therapy in seizure-naïve patients, reserving initiation for those who experience a first unprovoked seizure. Second- and third-generation agents with minimal hepatic enzyme induction—such as levetiracetam, lacosamide and brivaracetam—are preferred to older enzyme-inducing drugs that may alter chemotherapy pharmacokinetics. Treatment must be tailored to tumour type, location and concomitant treatments, with close attention to drug–drug interactions, neurotoxicity and psychiatric comorbidity. Intraoperative and early postoperative seizures warrant urgent evaluation and may predict chronic epilepsy risk, while status epilepticus in this population portends poorer survival and demands rapid intervention. A multidisciplinary approach integrating neuro-oncology, neurosurgery, neurology and nursing care is essential to balance antitumour efficacy and optimal seizure control throughout the patient’s disease trajectory.

Research from Nature Portfolio

Early postoperative seizures remain a critical challenge in patients undergoing craniotomy for intracranial tumours. A retrospective analysis of over 600 consecutive cases highlighted that approximately 5 % of patients experience seizures within days of surgery, with a higher incidence in those with meningioma and a history of preoperative seizures. Imaging findings often reveal a structural correlate in the majority of episodes, and nearly one-third of early postoperative seizure cases develop recurrent events within a year. Early seizures are associated with a significant decline in functional performance, emphasising the need for rapid diagnostic work-up and consideration of both acute antiseizure therapy and long-term management strategies to mitigate chronic epilepsy risk.

Antiepileptic Drug Management in Brain Tumor Patients publication trend

The graph below shows the total number of articles in antiepileptic drug management in brain tumor patients across all publications each year (not limited to Nature Index journals).

Technical terms

Brain tumour-related epilepsy (BTRE): Seizures resulting directly from the presence or treatment of an intracranial neoplasm.

Antiepileptic drug (AED): A medication used to prevent or reduce the frequency of seizures.

Enzyme-inducing AED: An antiepileptic agent that accelerates hepatic metabolism of itself and other drugs, potentially altering chemotherapy levels.

Prophylaxis: Preventive treatment administered in the absence of a first seizure.

Status epilepticus: A prolonged or rapidly recurring seizure requiring immediate medical intervention.

References

1. Antiepileptic Strategies for Patients with Primary and Metastatic Brain Tumors. Current Treatment Options in Oncology (2024).
2. Early postoperative seizures (EPS) in patients undergoing brain tumour surgery. Scientific Reports (2020).
3. Management of epilepsy in brain tumor patients. Current Opinion in Oncology (2022).