Authors :
Presenting Author: Kehan Zhao, MD – Upstate Medical University
Ruham Alshiekh-Nasany, MD – Neurology – Upstate Medical University; Nynoshka Bassatt-Cabrera, MD – Neurology – Upstate Medical University; Sherif Elwan, MD – Neurology – Upstate Medical University; Rebecca Rusnak, BS – Upstate Medical University; Roozbeh Tarighati Rasekhi, MD – Upstate Medical University; Shahram Izadyar, MD – Neurology – Upstate Medical University
Rationale:
Seizures and epilepsy can present symptoms of intracranial metastases or develop later in the course of the disease. Epileptic seizures significantly impact morbidity and quality of life, and remain a challenge in clinical management. Due to a lack of standardized approach for management of brain metastasis-related epilepsy, treatment decisions vary based on individual physician judgement. There is a need for studies to identify common and specific features of brain metastasis-related epilepsy that can guide clinical practice. In this study we present a retrospective review of a cohort of brain metastasis-related epilepsy cases at a single academic institution.
Methods:
We reviewed the medical records of patients 18 years of age and older at the time of diagnosis of metastatic brain lesion(s) from 2012 to 2022 at Upstate Medical University. Patients who had at least one seizure that was thought to be related to metastatic lesion(s) were included in the study. Patients with a history of previous epilepsy or functional (psychogenic non-epileptic) seizures were excluded. Patients who had a previous diagnosis of an age-specific epilepsy syndrome and at the time of diagnosis of metastatic brain lesion were beyond the expected affected age and had remained seizure-free off antiseizure medications were included.
Results:
Of the 2659 reviewed records, 373 patients (14.03%) had at least one seizure and met the inclusion criteria. Mean age at the time of metastasis diagnosis was 62.8 years +/- 11.9. Mean duration of follow-up after diagnosis of metastases was 4.3 months.
Seizure was the debut symptom of the brain metastases in 209 patients (56.03%). The size of the lesion was less than 2 cm in 45.50% of patients, 2 to 5 cm in 49.85% of patients, and larger than 5 cm in 4.75% of patients.
The primary source of metastases was from lung in 63.76%, breast in 9.26%, melanoma in 7.36%, GI in 4.09%, prostate in 1.09%, and other sources in 14.44% of patients. Antiseizure medications (ASM) were started in 91% of patients and at the last follow-up visit, 56% of patients were seizure free since initiating the first ASM.
Of the 192 patients who received radiation, 68 patients (35.41%) had seizure onset after radiation initiation. Of the 160 patients who received stereotactic radiosurgery, 49 patients (30.63%) had seizure onset after the procedure. Mean interval from radiotherapy to seizure onset was 20.14 months, and mean interval from stereotactic radiosurgery to seizure onset was 15.55 months. There were 41 patients who received gross total resection, of which 10 patients (24.39%) achieved seizure freedom after surgery, including one patient off ASM.
Conclusions:
Seizures and epilepsy were the presenting symptom of intracranial metastases in over half of our cohort (56.03%). Radiotherapy including stereotactic radiosurgery may impose additional seizure risk, which remains after radiotherapy with a mean seizure onset interval of 20.14 months. Despite multimodal treatment approaches, brain metastasis-related epilepsy is difficult to control.
Funding: None