P11.61.B TUMOR ASSOCIATED EPILEPSY AND RESTRICTION OF DRIVING PRIVILEGES IN THE FIRST YEAR AFTER BRAIN TUMOR SURGERY

Abstract

Abstract BACKGROUND In most countries, the risk of postoperative seizures prompts regulations restricting driving privileges at least temporarily following brain tumor operations. The present study investigated the frequency of epileptic seizures and driving habits in the first year after brain tumor operations in a prospective and a retrospective patient cohort. MATERIAL AND METHODS The authors studied overall 523 patients undergoing surgery for a brain tumor at the authors’ institution (prospective cohort, 09/2021-09/2022: N=313 and retrospective cohort, 01/2020-12/2020: N=210). Clinical data were obtained by reviewing patient charts and through (telephone) interviews. RESULTS The cohort included 160 (30.6%) meningiomas, 135 (25.6%) glioblastomas, 111 (21.2%) metastases and 56 (10.7%) other gliomas. 135/523 (25.8%) presented with seizure(s). At 3 months (excluding early post operative seizures) overall 57 (10.9%; prospective vs. retrospective cohort: 13.2 vs. 8.1%) patients reported seizure(s). The seizure incidence at 1 year was 18.4% (prospective vs. retrospective cohort: 18.7 vs. 18.2%). 22/173 (12.7%) patients reported de-novo seizures at 1 year. Significant predictors of seizures at 1 year included preoperative seizures (p<0.001), an adverse preoperative and postoperative KPI (p=0.038 and p=0.001) as well as postoperative NANO (p<0.001) score and histology (e.g. meningiomas: 7.5%, metastases: 22.0%, glioblastomas: 38.5%, other gliomas: 18.8%; p<0.001). 219/318 (69.9%) assessable patients were not driving in 3 months. Reasons included no driver’s license (6.3%), death (7.9%), neurological deficits (38.4%), epilepsy (9.0%), and personal choice (12.9%). 91.3% of glioblastoma patients did not drive in 3 months (cf. metastases: 77.8%, other gliomas. 72.4%, meningiomas: 43.8%; p<0.001). CONCLUSION We documented a high incidence of postoperative seizures and potential risk factors in patients following brain tumor surgery. Our figures support postoperative restriction of driving privileges even in seizure-naive patients (12.7% de-novo seizures at 1 year). Of note, epilepsy was the reason for not driving after surgery for a brain tumor only in 9.0%.