Risk factors for the development of epilepsy in patients with brain metastases

Author:

Wolpert Fabian1,Lareida Anna1,Terziev Robert1,Grossenbacher Bettina1,Neidert Marian C2,Roth Patrick1,Poryazova Rositsa1,Imbach Lukas L1,Le Rhun Emilie3,Weller Michael1ORCID

Affiliation:

1. Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland

2. Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland

3. Neuro-oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Lille, France; Neurology, Department of Medical Oncology, Oscar Lambret Center, Lille, France and Inserm U-1192, Villeneuve d’Ascq, France

Abstract

Abstract Background Current guidelines do not recommend primary prophylactic anti-epileptic drug (AED) therapy for patients with brain metastases (BM). Yet, subgroups of patients at high seizure risk might still benefit from prophylaxis. Methods We identified 799 patients diagnosed with BM by retrospective screening of our electronic chart system. Candidate risk factors for the development of epilepsy were tested by univariate and multivariate Cox regression models. Results Epilepsy was diagnosed in 226 of 799 patients (28%). Risk factors for epilepsy in non-operated patients were single BM (P = 0.002, hazard ratio [HR] 3.2, 95% CI: 1.5–6.6) and detection of tumoral hemorrhage (P = 0.008, HR 2.5, 95% CI: 1.3–4.9). Preoperative seizures occurred predominantly in patients with supratentorial BM (P = 0.003, HR 20.78, 95% CI: 2.8–153.4) and lung cancer (P = 0.022; HR 2.0, 95% CI: 1.1–3.6). Postoperative seizures were associated with supratentorial localization (P = 0.017, HR 5.8, 95% CI: 1.4–24.3), incomplete resection (P = 0.005, HR 4.6, 95% CI: 1.6–13.1), and by trend for multiple brain surgeries (P = 0.095, HR 1.9, 95% CI: 0.9–4.0). These risk factors were integrated into a predictive score model for postoperative epilepsy (score sum 0–8). A gradual increase of seizure rates along with higher sum score was confirmed post hoc (score 0 = no seizures; score 8 = 48% seizures). Receiver operating characteristic analysis supported diagnostic accuracy (P = 0.00001, area under the curve = 0.75). Conclusions Here we have defined risk profiles for the development of BM-related epilepsy and derived a score which might help to estimate the risk of postoperative seizures and identify individuals at risk who might benefit from primary prophylactic AED therapy.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Neurology (clinical),Oncology

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