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Epilepsy in brain metastasis: an emerging entity


Purpose of review

The purpose of this review is to highlight advances in the management of seizures in brain metastases from solid tumors.

Recent findings

The highest risk for seizures is in patients with melanoma and lung cancer. There is lack of data on the efficacy of antiepileptic drugs (AEDs), but interactions between enzyme-inducing AEDs and anticancer agents must be avoided. Levetiracetam and valproic acid are the most appropriate drugs. Prophylaxis with AEDs for patients with brain metastases without a history of seizures is not recommended. Total resection of a brain metastasis allows complete seizure control. Seizures may represent an adverse effect of stereotactic radiosurgery or of high-dose chemotherapy.


New preclinical and clinical studies should define the risk of brain metastasis in light of the new treatment options in the different tumor types. New clinical trials should be designed in patients with brain metastases in terms of treatment or prophylaxis of seizures.

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References and Recommended Reading

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Correspondence to Roberta Rudà MD.

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Dr. Roberta Rudà declares that she has no conflict of interest. Dr. Francesca Mo declares that she has no conflict of interest. Dr. Alessia Pellerino declares that she has no conflict of interest.

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Rudà, R., Mo, F. & Pellerino, A. Epilepsy in brain metastasis: an emerging entity. Curr Treat Options Neurol 22, 6 (2020).

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  • Brain metastases
  • Seizures
  • Epilepsy
  • Antiepileptic drugs
  • Interactions