Seizures are common in patients with brain tumors, and epilepsy can
significantly impact patient quality of life. Therefore, a thorough
understanding of rates and predictors of seizures, and the likelihood of seizure
freedom after resection, is critical in the treatment of brain tumors. Among all
tumor types, seizures are most common with glioneuronal tumors (70–80%),
particularly in patients with frontotemporal or insular lesions. Seizures are
also common in individuals with glioma, with the highest rates of epilepsy
(60–75%) observed in patients with low-grade gliomas located in
superficial cortical or insular regions. Approximately 20–50% of patients
with meningioma and 20–35% of those with brain metastases also suffer
from seizures. After tumor resection, approximately 60–90% are rendered
seizure-free, with most favorable seizure outcomes seen in individuals with
glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack
of generalized seizures are common predictors of a favorable seizure outcome.
With regard to anticonvulsant medication selection, evidence-based guidelines
for the treatment of focal epilepsy should be followed, and individual patient
factors should also be considered, including patient age, sex, organ
dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly
forms an essential part of glioma treatment, enzyme-inducing anticonvulsants
should be avoided when possible. Seizure freedom is the ultimate goal in the
treatment of brain tumor patients with epilepsy, given the adverse effects of
seizures on quality of life.