Seizure outcomes in patients with brain metastases and epilepsy: a systematic review on the efficacy of antitumor treatment and antiseizure medication.

BACKGROUND

Epilepsy is a common symptom in patients with brain metastases (BMs), and because of the rising incidence of BMs, adequate seizure management is warranted. We conducted a systematic review on seizure outcomes after antitumor treatment and antiseizure medication (ASM) in patients with BMs from solid tumors and epilepsy.

METHODS

A literature search was performed in 6 databases up to February 2024. Extracted outcomes were rates for (1) seizure freedom, (2) ≥50% seizure reduction, and (3) treatment failure (for ASM only). Weighted averages (WAs) were calculated for outcomes after surgery at 6 months follow-up. Quality assessment of the included studies was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool.

RESULTS

We retrieved 2244 references, of which 16 studies were eligible for inclusion. Eight studies were at critical, and 8 studies at serious risk of bias. The WA of seizure freedom rates at 6 months after surgical resection was 64% (based on 3 studies at serious risk of bias,  = 151 patients). Results on ASM efficacy and tolerability were unreliable, as all eligible studies for these outcomes were at critical risk of bias.

CONCLUSIONS

Limited available evidence from heterogeneous study populations demonstrated that in the majority of patients with epilepsy due to BMs, seizure freedom 6 months after surgical resection may be reached. No substantial evidence on ASM efficacy and tolerability in patients with epilepsy due to BMs is available. High-quality cohort studies are warranted to expand the evidence on seizure outcomes after antitumor and ASM treatment.