Incidence of seizure in adult patients with intracranial metastatic disease

Chan, Vivien; Sahgal, Arjun; Egeto, Peter; Schweizer, Tom A.; Das, Sunit

doi:10.1007/s11060-016-2335-2

Cited by 31 publications

(35 citation statements)

References 34 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%

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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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%

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: 64%

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

Witteler

Kjær

Tvilsted

et al. 2020

In Vivo

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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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Section: Introductionmentioning

confidence: 99%

“…Seizures are among the most common symptoms in patients with brain tumors with a consikderable incidence in patients with brain metastases (BM) albeit lower when compared to primary brain tumors [2]. This lower incidence seems to be related to the less in ltrative growth pattern resulting in more circumscribed lesions [9].…”

Section: Introductionmentioning

confidence: 99%

Tumor-Associated Epilepsy in Patients With Brain Metastases: Necrosis-to-Tumor Ratio Forecasts Postoperative Seizure Freedom

Bahna

Heimann

Bode

et al. 2021

Preprint

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Surgical resection is highly effective in the treatment of tumor-related epilepsy (TRE) in patients with brain metastases (BM). Nevertheless, some patients suffer from postoperative persistent epilepsy which negatively impacts health-related quality of life. Therefore, early identification of patients with potentially unfavorable seizure outcome after BM resection is important. Patients with TRE that had undergone surgery for BM at the authors’ institution between 2013 and 2018 and were analyzed with regard to preoperatively identifiable risk factors for unfavorable seizure outcome. Tumor tissue and tumor necrosis ratios were assessed volumetrically. According to the classification of the International League Against Epilepsy (ILAE), seizure outcome was categorized as favorable (ILAE 1) and unfavorable (ILAE 2 - 6) after 3 months in order to avoid potential interference with adjuvant cancer treatment.Among all 38 patients undergoing neurosurgical treatment for BM with concomitant TRE, 34 patients achieved a favorable seizure outcome (90%). Unfavorable seizure outcome was significantly associated with larger tumor volumes (p=0.012), a midline shift > 7 mm (p=0.025), and a necrosis/tumor volume ratio > 0.2 (p=0.047).The present study identifies preoperatively collectable risk factors for unfavorable seizure outcome in patients with BM and TRE. This might enable to preselect for highly vulnerable patients with postoperative persistent epilepsy who might benefit from accompanying neuro-oncological expertise during further systemical treatment regimes.

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Incidence of seizure in adult patients with intracranial metastatic disease

Cited by 31 publications

References 34 publications

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

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

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

Tumor-Associated Epilepsy in Patients With Brain Metastases: Necrosis-to-Tumor Ratio Forecasts Postoperative Seizure Freedom

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