Abstract
Patients with both primary and metastatic brain tumors have significant seizure burden due to their tumor. The management of tumor-related epilepsy (TRE) and optimizing antiepileptic drug (AED) regimens requires collaboration between neurologists and seizure specialists, which is facilitated by seizure documentation in clinic notes. We aim to describe seizure incidence in patients seen in neuro-oncology clinical practice. Further, in the subset of those patients with TRE, we aim to analyze seizure documentation. This is a retrospective review of patients with a primary or metastatic brain tumor seen in a neuro-oncology clinic in October 2019. Patients with TRE were included in the analysis of seizure documentation. These notes were analyzed for inclusion of seizure descriptors, terminology, AED regimens, and changes in management. Of the full cohort of 356 patients, 199 (55.9%) had TRE. Anaplastic astrocytomas had the highest percentage of patients with TRE. The analysis of seizure documentation in patients with TRE revealed that the majority of notes (90.9%) mentioned seizures. Fewer notes (39.6%) provided additional descriptions of the seizures or commented on AED regimens (58.3%). In notes for patients who had seizures within the previous 6 months, seizure descriptors were more likely. This study defines the TRE burden in a cohort of patients seen in neuro-oncology clinic. Among patients with TRE, our study shows that documentation of many aspects of the characteristics and management of patient seizures can be improved, which would facilitate further analysis of impact on patient care as well as future research.
Highlights
Patients with both primary brain tumors and brain metastases have significant seizure burden due to their lesion(s), with up to 90% of patients having epilepsy as a consequence of their cancer [1,2,3]
The analysis of seizure documentation in patients with Tumor related epilepsy (TRE) revealed that the majority of notes (90.9%) mentioned seizures; fewer notes provided seizure frequency (51.3%), seizure descriptions (39.7%) or commented on antiepileptic drug (AED) regimens (58.3%)
The underlying mechanisms of TRE are not fully understood, higher rates of epilepsy have been reported in patients with low grade gliomas, larger tumor volumes, frontal tumor location, and molecular markers such as the IDH1 mutation [1,2,3,4,5]
Summary
Patients with both primary brain tumors and brain metastases have significant seizure burden due to their lesion(s), with up to 90% of patients having epilepsy as a consequence of their cancer [1,2,3]. Tumor related epilepsy (TRE) is often resistant to medical management and presents a significant source of mortality and morbidity in patients with brain tumors [1,2,3,4,5,6]. The underlying mechanisms of TRE are not fully understood, higher rates of epilepsy have been reported in patients with low grade gliomas, larger tumor volumes, frontal tumor location, and molecular markers such as the IDH1 mutation [1,2,3,4,5]. It can be hypothesized that direct tumor cell-neuronal interaction could comprise another mechanism [8, 9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
