Brain tumor–related epilepsy and risk factors for metastatic brain tumors: analysis of 601 consecutive cases providing real-world data

Kenichiro Asano MD, PhD1, Seiko Hasegawa MD, PhD2, Masashi Matsuzaka MD, PhD3,4, and Hiroki Ohkuma MD, PhD1
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  • 1 Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki;
  • | 2 Department of Neurosurgery, Kuroishi General Hospital, Kuroishi; and
  • | 3 Clinical Research Support Center, and
  • | 4 Department of Medical Informatics, Hirosaki University Hospital, Hirosaki, Aomori, Japan
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OBJECTIVE

It is necessary to accurately characterize the epidemiology and trends of brain tumor–related epilepsy (BTE) in patients with metastatic brain tumors. This study aimed to determine the incidence of BTE associated with metastatic brain tumors and retrospectively investigate the risk factors for BTE.

METHODS

This retrospective analysis included 601 of 631 consecutive patients with metastatic brain tumors who received treatment, including surgery, radiotherapy, and/or other treatments. BTE and the clinical course were examined retrospectively. Logistic regression multivariate analyses were performed to identify risk factors for BTE.

RESULTS

BTE was reported in 148 (24.6%) of 601 patients during the entire course. Of these 148 patients, 81 (54.7%) had first-onset epilepsy (13.5% of all patients). Of the 520 cases of nonepileptic onset, 53 were in the prophylactic antiepileptic drug (AED) group. However, 12 of these patients and 55 of the no–prophylactic AED group developed epilepsy during the course of the study. Including these 67 patients, 148 patients were examined as the group of all epilepsy cases during the entire course. In 3 patients, the seizure progressed to status epilepticus. In most patients, the BTE (n = 83, 56.1%) manifested as focal aware seizures. Logistic regression analysis identified young age (p = 0.037), male sex (p = 0.026), breast cancer (p = 0.001), eloquent area (p < 0.001), peritumoral edema (p < 0.001), dissemination (p = 0.013), and maximum tumor volume (p = 0.021) as significant risk factors for BTE. BTE was more common with tumor volumes greater than the cutoff value of 1.92 ml.

CONCLUSIONS

BTE appears to be more likely to occur in cases with young age, male sex, breast cancer, tumors involving eloquent areas, brain edema, dissemination, and giant tumors.

ABBREVIATIONS

AED = antiepileptic drug; AOR = adjusted odds ratio; AUC = area under the curve; BTE = brain tumor–related epilepsy; GIC = gastrointestinal cancer; GKS = Gamma Knife surgery; LEV = levetiracetam; NSCLC = non-SCLC; RCC = renal cell cancer; RT = radiotherapy; SCLC = small cell lung cancer; SPGR = spoiled gradient echo; SRS = stereotactic radiosurgery; SRT = stereotactic RT; VPA = valproic acid; WBRT = whole-brain RT; ZNS = zonisamide.

Supplementary Materials

    • Supplementary Table 1 (PDF 382 KB)

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Contributor Notes

Correspondence Kenichiro Asano: Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan. asanoken@hirosaki-u.ac.jp.

INCLUDE WHEN CITING Published online July 16, 2021; DOI: 10.3171/2020.11.JNS202873.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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