Epilepsy in brain metastasis: an emerging entity

Rudà, Roberta; Mo, Francesca; Pellerino, Alessia

doi:10.1007/s11940-020-0613-y

Cited by 22 publications

(33 citation statements)

References 51 publications

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“…It evaluated the prevalence of pre-operative seizures, risk factors for occurrence of seizures and associations with OS. The prevalence of preoperative seizures was 34.6%, which was within but on the top end of the range of 12-35% reported in the literature (3,5,16,17). This comparably high prevalence may be explained to a certain extent by the fact that many patients (49%) in our study were lung cancer patients.…”

supporting

confidence: 67%

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Pre-operative Seizures in Patients With Single Brain Metastasis Treated With Resection Plus Whole-Brain Irradiation and a Boost

Rades

Witteler

Kjær

et al. 2020

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Background/Aim: Seizures can be the initial symptom of brain metastases. This study investigated pretreatment seizures in patients with a single lesion. Patients and Methods: Pre-operative seizures were analyzed in 104 patients with a single brain metastasis receiving resection plus whole-brain irradiation and a boost. Prevalence of seizures, risk factors and associations with survival (OS) were evaluated. Results: Thirty patients (34.6%) had seizures prior to neurosurgery. Significant associations between seizures and investigated characteristics were not found. However, age ≤61 years showed a trend (p=0.117) for increased incidence of seizures. Time from diagnosis of malignancy until neurosurgery >12 months was significantly associated with improved OS on univariate analysis (p=0.003). Trends for a positive association with OS were found for no seizures (p=0.054), female gender (p=0.066) and breast cancer (p=0.098). On multivariate analysis, time until neurosurgery >12 months was independently associated (p=0.019) with better OS, and seizures showed a trend (p=0.119) for improved OS. Conclusions: Considering the high prevalence of seizures in this cohort, regular screening and monitoring of these patients appears reasonable. This applies particularly to patients aged ≤61 years. Metastasis to the brain represents a relatively common situation in adult cancer patients and is often associated with serious symptoms impairing quality of life (1, 2). With respect to the number of lesions, patients can be classified as having single brain metastasis, oligo-metastatic disease (usually up to three lesions) or multiple brain metastases (usually more than three lesions) (2). A serious problem in patients with brain metastasis is the occurrence of seizures (3). Seizures can occur prior to the start of treatment and even be the initial symptom leading to the diagnosis of brain metastasis. Pre-treatment seizures appear much more common than seizures occurring during treatment or follow-up (3). Moreover, occurrence of seizures may be associated with the number of intracerebral lesions. However, the data reported appear conflicting. In the study of Wu et al., pre-operative seizures were significantly associated with more than two intracerebral lesions, whereas in the study of Wolpert et al., no significant association between pre-operative seizures and the number of brain metastases was observed (4, 5). Nevertheless, in the study of Wolpert et al., single brain metastasis was the most important risk factor for seizures in non-operated patients (5). It appears reasonable to perform separate studies in patients with single, limited numbers or multiple intracerebral lesions, as well as in patients treated with or without neurosurgical resection to properly define the role of seizures in patients with brain metastasis. This study focused on patients with a single intracerebral lesion who received resection of their metastasis followed by whole-brain irradiation (WBI) and a boost to the resection cavity. Patients and Methods Patien...

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supporting

confidence: 67%

“…It has been previously shown by Wolpert et al that patients with lung cancer have increased incidence of seizures (5). Moreover, in the review article of Ruda et al, lung cancer patients had the second highest prevalence of seizures of all primary tumor types (3).…”

mentioning

confidence: 91%

Pre-operative Seizures in Patients With Single Brain Metastasis Treated With Resection Plus Whole-Brain Irradiation and a Boost

Rades

Witteler

Kjær

et al. 2020

In Vivo

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“…In the present study, the prevalence of seizures was 24.1%, which was within the range of 12-35% reported for patients with cerebral metastases (8,(12)(13)(14). Another issue investigated in the current study was the identification of risk factors for the occurrence of seizures, but no significant risk factors were identified.…”

supporting

confidence: 65%

“…Another previously identified risk factor for occurrence of seizures is the primary tumor type (1,12). Due to the fact that the patients of this study represented a very specific group, the distribution of primary tumors was different to other series, particularly regarding the proportion of melanoma patients (2,(15)(16)(17)(18)(19)(20).…”

mentioning

confidence: 79%

“…Therefore, a local therapy like SRS supplemented by WBRT is still a good option for many patients with 1-3 cerebral lesions (2, 5-7). Patients assigned to this treatment regimen are at risk of experiencing seizures, mostly prior to the start of treatment (12). The probability of pre-treatment seizures depends on the type of treatment and the number of lesions (8,9).…”

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confidence: 99%

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Pre-Treatment Seizures in Patients With 1-3 Cerebral Metastases Receiving Local Therapies Plus Whole-brain Radiotherapy

Witteler

Kjær

Tvilsted

et al. 2020

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Background/Aim: Seizures impair patients' quality of life. The prognostic role of pre-treatment seizures in patients with 1-3 cerebral metastases receiving local therapies plus whole-brain radiotherapy (WBRT) was investigated. Patients and Methods: In 249 patients, prevalence, risk factors and associations of pre-treatment seizures with survival were retrospectively evaluated. Age, gender, performance score, tumor type, number of lesions, extra-cerebral metastases, and time from tumor diagnosis to treatment of cerebral metastasis were analyzed for associations with seizures. These characteristics and pretreatment seizures were also analyzed for associations with survival. Results: The prevalence of pre-treatment seizures was 24.1%. Trends for associations were found between seizures and gender or performance score. On multivariate analysis, age (p=0.008), performance score (p=0.004), tumor type (p<0.001) and extra-cerebral metastasis (p<0.001) were significantly associated with survival. Conclusion: Seizures were comparably common prior to local therapies plus WBRT for cerebral metastases. No factor was found to be significantly associated with seizures, and seizures were not associated with survival. Seizures are a serious problem in patients with both primary and secondary brain tumors (1). For the latter group, different 2727 This article is freely accessible online.

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