Neurology: Patients with tumor brain metastasis may consider using epilepsy drugs to reduce the risk of seizures

Brain metastases (BrM) affect 20-40% of patients with solid malignancies and are associated with significant clinical sequelae, including seizures.
seizures are a symptom of BRM diagnosed in about 10-20% of patients, although according to previous studies, estimates vary.
patients with seizures should start taking anti-epileptic drugs (antiseizure medication, ASM) to reduce the development of further seizures.
in patients who did not have seizures at the time of BrM diagnosis, the subsequent rate of seizures is still vaguely described.
While current guidelines do not recommend starting ASM after a patient with epilepsy has been diagnosed with BrM, they are based primarily on a limited number of small, single-center studies with small sample sizes and high queue heterogeneity, which do not show a significant reduction in the risk of seizures in patients receiving ASMs and those who do not.
addition, the increasing use of treatments associated with late-stage inflammation or necrosis, such as stereotactic radiotherapy and immunotherapy, may increase the risk of seizures in contemporary queues.
The occurrence of seizures can be extremely damaging to the quality of life of patients, as the activity of patients with seizures is restricted, and seizures often lead to emergency department visits, which can be avoided if preventive ASMs are used, which benefits both patients and the health care system.
, it is necessary to reconsider the pre-use of ASMs in some BrM patients in current treatments.
, Nayan Lamba of Harvard University and others looked at whether the risk of subsequent seizures increased in patients with tumor brain metastasis (BrM), which has not yet been shown to be a seizure, and analyzed the corresponding seizure rates and risk factors.
they included 15,863 and 1,453 BRM patients, respectively, using surveillance, epidemiology and final results (SEER)-Medicare data (2008-2016) and Brigham and Women's Hospital/Dana Farber Cancer Institute (2000-2015).
describe seizure rates and risk factors through cumulative rate curves and Fine/Gray competitive risk regression.
results showed that 1,588 (10.0%) and 169 (11.6%) of SEER-Medicare and institutional patients had seizures, respectively.
In the SEER-Medicare queue, seizure risk factors included: African-American vs. White Race (HR=1.45), Urban vs. Non-Urban Residence (HR=1.41), Melanoma vs. Non-Small Cell Lung Cancer (HR=1.44), and exposure to brain-directed stereotactic radiation (HR=1.67).
In the tissue queue, melanoma and non-small cell lung cancer (HR=1.70), diagnosis greater than 4 BrM (HR=1.60), presence of BrM (HR=3.62) in high-risk locations, and lack of local brain-oriented therapy (HR=3.08) were associated with a greater risk of seizure development.
importance of this study is that anti-epileptic drugs can be used appropriately in some BrM patients, especially those with melanoma, a high burden of intracranial disease, and BrM in high-risk areas.
original origin of Lamba, N., Catalano, P. J., Cagney, D.N., Haas-Kogan, D.A., Bubrick, E. J., Wen, P. Y., and A. Aizer, A. A. Appres Patients with Brain Metastases: A People-and-Institutional-Level Analysis. Neurology.<!--5f39ae17-8c62-4a45-bc43-b32064c9388a: W3siYmxvY2tJZCI6IjM4OTYtMTYxMDg4MTk5NTM4OCIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJhbGlnbiI6ImxlZnQiLCJpbmRlbnQiOjAsInRleHQtaW5kZW50IjowLCJsaW5lLWhlaWdodCI6MS43NSwiYmFjay1jb2xvciI6IiIsInBhZGRpbmciOiIifSwidHlwZSI6InBhcmFncmFwaCIsInJpY2hUZXh0Ijp7ImRhdGEiOlt7ImNoYXIiOiJBIn0seyJjaGFyIjoibiJ9LHsiY2hhciI6Im4ifSx7ImNoYXIiOiJhIn0seyJjaGFyIjoicyJ9LHsiY2hhciI6ImwifSx7ImNoYXIiOiIgIn0seyJjaGFyIjoibyJ9LHsiY2hhciI6ImYif Sx7ImNoYXIiOiIgIn0seyJjaGFyIjoiTiJ9LHsiY2hhciI6ImUifSx7ImNoYXIiOiJ1In0seyJjaGFyIjoiciJ9LHsiY2hhciI6Im8ifSx7ImNoYXIiOiJsIn0seyJjaGFyIjoibyJ9LHsiY2hhciI6ImcifSx7ImNoYXIiOiJ5In0seyJjaGFyIjoiLSJ9LHsiY2hhciI6IuiCvyJ9LHsiY2hhciI6IueYpCJ9LHsiY2hhciI6IuiEkSJ9LHsiY2hhciI6Iui9rCJ9LHsiY2hhciI6IuenuyJ9LHsiY2hhciI6IuaCoyJ9LHsiY2hhciI6IuiAhSJ9LHsiY2hhciI6Iu +8jCJ9LHsiY2hhciI6IuWPryJ9LHsiY2hhciI6IuiAgyJ9LHsiY2hhciI6IuiZkSJ9LHsiY2hhciI6IuS9vyJ9LHsiY2hhciI6IueUqCJ9LHsiY2hhciI6IuW9kyJ9LHsiY2hhciI6IueZqyJ9LHsiY2hhciI6IueXqyJ9LHsiY2hhciI6IuiNryJ9LHsiY2hhciI6IueJqSJ9LHsiY2hhciI6IumZjSJ9LHsiY2hhciI6IuS9jiJ9LHsiY2hhciI6IueZqyJ9LHsiY2hhciI6IueXqyJ9LHsiY2hhciI6IuWPkSJ9LHsiY2hhciI6IuS9nCJ9LHsiY2hhciI6IumjjiJ9LHsiY2hhciI6IumZqSJ9XSwiaXNSaWNoVGV4dCI6dHJ1ZSwia2VlcExpbmVCcmVhayI6dHJ 1ZX19LHsiYmxvY2tJZCI6IjI5NTItMTYxMDg4MzM2MjIxMCIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJhbGlnbiI6ImxlZnQiLCJpbmRlbnQiOjAsInRleHQtaW5kZW50IjowLCJsaW5lLWhlaWdodCI6MS43NSwiYmFjay1jb2xvciI6IiIsInBhZGRpbmciOiIifSwidHlwZSI6InBhcmFncmFwaCIsInJpY2hUZXh0Ijp7ImRhdGEiOltdLCJpc1JpY2hUZXh0Ijp0cnVlLCJrZWVwTGluZUJyZWFrIjp0cnVlfX0seyJibG9ja0lkIjoiMjYyOS0xNjEwODgzMzYyMzQ1IiwiYmxvY2tUeXBlIjoicGFyYWdyYXBoIiwic3R5bGVzIjp7ImFs aWduIjoibGVmdCIsImluZGVudCI6MCwidGV4dC1pbmRlbnQiOjAsImxpbmUtaGVpZ2h0IjoxLjc1LCJiYWNrLWNvbG9yIjoiIiwicGFkZGluZyI6IiJ9LCJ0eXBlIjoicGFyYWdyYXBoIiwicmljaFRleHQiOnsiZGF0YSI6W3siY2hhciI6IuiCvyJ9LHsiY2hhciI6IueYpCJ9LHsiY2hhciI6IuiEkSJ9LHsiY2hhciI6Iui9rCJ9LHsiY2hhciI6IuenuyJ9LHsiY2hhciI6IigifSx7ImNoYXIiOiJCIn0seyJjaGFyIjoiciJ9LHsiY2hhciI6ImEifSx7ImNoYXIiOiJpIn0seyJjaGFyIjoibiJ9LHsiY2hhciI6IiAifSx7ImNoYXIiOiJtIn0seyJjaGFyI joiZSJ9LHsiY2hhciI6InQifSx7ImNoYXIiOiJhIn0seyJjaGFyIjoicyJ9LHsiY2hhciI6InQifSx7ImNoYXIiOiJhIn0seyJjaGFyIjoicyJ9LHsiY2hhciI6ImUifSx7ImNoYXIiOiJzIn0seyJjaGFyIjoi77yMIn0seyJjaGFyIjoiQiJ9LHsiY2hhciI6InIifSx7ImNoYXIiOiJNIn0seyJjaGFyIjoiKSJ9LHsiY2hhciI6IuW9sSJ9LHsiY2hhciI6IuWTjSJ9LHsiY2hhciI6IuedgCJ9LHsiY2hhciI6IjIifSx7ImNoYXIiOiIwIn0seyJjaGFyIjoiLSJ9LHsiY2hhciI6IjQifSx7ImNoYXIiOiIwIn0seyJjaGFyIjoiJSJ9LHsiY2hhciI6IueahC J9LHsiY2hhciI6IuWuniJ9LHsiY2hhciI6IuS9kyJ9LHsiY2hhciI6IuaBtiJ9LHsiY2hhciI6IuaApyJ9LHsiY2hhciI6IuiCvyJ9LHsiY2hhciI6IueYpCJ9LHsiY2hhciI6IuaCoyJ9LHsiY2hhciI6IuiAhSJ9LHsiY2hhciI6Iu+ 8jCJ9LHsiY2hhciI6IuW5tiJ9LHsiY2hhciI6IuS4jiJ9LHsiY2hhciI6IumHjSJ9LHsiY2hhciI6IuWkpyJ9LHsiY2hhciI6IueahCJ9LHsiY2hhciI6IuS4tCJ9LHsiY2hhciI6IuW6iiJ9LHsiY2hhciI6IuWQjiJ9LHsiY2hhciI6IumBlyJ9LHsiY2hhciI6IueXhyJ9LHsiY2hhciI6IuaciSJ9LHsiY2hhciI6IuWFsyJ9LHsiY2hhciI6Iu+ 8jCJ9LHsiY2hhciI6IuWMhSJ9LHsiY2hhciI6IuaLrCJ9LHsiY2hhciI6IueZqyJ9LHsiY2hhciI6IueXqyJ9LHsiY2hhciI6IuWPkSJ9LHsiY2hhciI6IuS9nCJ9LHsiY2hhciI6IuOAgiJ9LHsiY2hhciI6IueZqyJ9LHsiY2hhciI6IueXqyJ9LHsiY2hhciI6IuWPkSJ9LHsiY2hhciI6IuS9nCJ9LHsiY2hhciI6IuaYryJ9LHsiY2hhciI6IuWkpyJ9LHsiY2hhciI6Iue6piJ9LHsiY2hhciI6IjEifSx7ImNoYXIiOiIwIn0seyJjaGFyIjoiLSJ9LHsiY2hhciI6IjIifSx7ImNoYXIiOiIwIn0seyJjaGFyIjoiJSJ9LHsiY2hhciI6IuaCoyJ9LHsiY2hh ciI6IuiAhSJ9LHsiY2hhciI6IuiiqyJ9LHsiY2hhciI6IuiviiJ9LHsiY2hhciI6IuaWrSJ9LHsiY2hhciI6IuS4uiJ9LHsiY2hhciI6IkIifSx7ImNoYXIiOiJ