Management of Brain Tumor–Related Epilepsy: Understanding Seizure Control and Patient Care

Management of Brain Tumor–Related Epilepsy: Understanding Seizure Control and Patient Care

Brain tumor–related epilepsy (BTRE) is a significant concern for patients diagnosed with both primary and metastatic brain tumors. Seizures not only affect quality of life but can complicate treatment and increase emotional distress. Fortunately, with the right approach, BTRE can often be effectively managed. This guide explores why seizures occur in brain tumor patients, how they are diagnosed, and the current best practices for treatment and long-term care.

Understanding the Link Between Brain Tumors and Seizures

A seizure occurs when abnormal electrical activity in the brain leads to temporary changes in behavior, consciousness, or movement. Brain tumors—both malignant and benign—can disrupt this electrical activity. In fact, seizures are often one of the earliest symptoms of a brain tumor.

Seizure risk depends on factors such as:

Tumor location (cortical tumors are more likely to cause seizures)

Tumor type (low-grade gliomas have a higher seizure risk than high-grade)

Growth rate and surrounding brain irritation

Surgical intervention and post-operative changes

Approximately 30% to 50% of brain tumor patients will experience seizures at some point. Seizures may present as generalized convulsions or focal seizures with symptoms like twitching, unusual sensations, or brief confusion.

Diagnosing BTRE

The diagnosis of brain tumor–related epilepsy involves a comprehensive evaluation to determine the type of seizure and its relationship to the tumor. Key diagnostic tools include:

Neurological examination to assess cognitive and motor function

MRI and CT scans to locate the tumor and identify structural abnormalities

Electroencephalogram (EEG) to detect abnormal brain activity and confirm seizure origin

An accurate diagnosis is critical not only for controlling seizures but also for optimizing cancer treatment plans and minimizing complications.

First-Line Management: Antiepileptic Drugs (AEDs)

The cornerstone of BTRE management is antiepileptic medication. These drugs help prevent seizures by stabilizing electrical activity in the brain.

Commonly prescribed AEDs include:

Levetiracetam (Keppra) – often preferred for its low interaction with cancer therapies

Valproate (Depakote) – effective but associated with more side effects

Lamotrigine or Lacosamide – alternatives for patients with tolerability issues

Treatment is typically started after the first seizure. However, in patients with high-risk tumor locations or visible cortical irritation, prophylactic use may be considered post-surgery.

Guidelines recommend monotherapy (using one AED) to minimize side effects unless seizures persist, at which point a second drug may be added.

Surgical Intervention and Seizure Control

For patients whose tumors are operable, surgical resection not only treats the cancer but may also reduce or eliminate seizures. The likelihood of seizure freedom increases when:

The entire tumor is removed

The seizure focus overlaps with the tumor site

Surgery is performed early in the disease course

Intraoperative EEG monitoring and functional mapping help ensure critical brain areas are preserved while targeting seizure-producing tissue. Studies show that up to 70% of patients with low-grade tumors may experience seizure freedom after surgery.

Radiotherapy and Chemotherapy Considerations

Radiotherapy and chemotherapy, while aimed at treating the tumor, can influence seizure frequency. Radiation may temporarily increase seizure risk due to brain swelling, while some chemotherapy agents can alter AED metabolism.

Close monitoring is essential during:

Radiation planning to avoid high-risk seizure zones

Chemotherapy cycles, particularly when using drugs like temozolomide, which may interact with liver enzymes

Oncologists and neurologists coordinate to ensure treatment adjustments maintain seizure control without compromising cancer care.

Managing Side Effects and Quality of Life

Seizures and AEDs can cause side effects such as fatigue, dizziness, mood changes, and cognitive impairment. These symptoms may be compounded by cancer itself or its treatments.

Supportive strategies include:

Medication adjustment to balance seizure control and side effect tolerance

Neuropsychological support for memory or concentration issues

Physical and occupational therapy for post-seizure or post-surgical rehabilitation

Quality of life is a top priority in BTRE management. Education, lifestyle modifications, and mental health support can significantly reduce the burden on patients and families.

Lifestyle and Safety Recommendations

Living with seizures requires practical safety measures:

Avoid activities that risk injury during a seizure (e.g., swimming alone, driving)

Create a seizure response plan and inform caregivers

Maintain a regular sleep schedule, as fatigue can trigger seizures

Avoid alcohol or drugs that lower seizure threshold

In most regions, seizure-free periods of 6 to 12 months are required before resuming driving. Discuss local laws and individual risk with your care team.

Frequently Asked Questions About Brain Tumor–Related Epilepsy

Can seizures be completely controlled?

Yes, many patients achieve seizure freedom with appropriate treatment, especially if the tumor is surgically removed or responds to therapy.

Do all brain tumor patients have seizures?

No. While seizures are common, they do not occur in every case and depend on tumor type, location, and individual factors.

Are AEDs lifelong medications?

Not always. If a patient remains seizure-free and the tumor is stable or resolved, doctors may consider tapering AEDs under supervision.

Is epilepsy a sign of worsening cancer?

Not necessarily. However, new or increasing seizure activity should prompt evaluation to rule out tumor progression or treatment complications.

Conclusion

Managing brain tumor–related epilepsy involves more than just controlling seizures—it’s about improving the patient’s quality of life through collaborative, personalized care. With effective use of antiepileptic drugs, surgical strategies, and supportive therapies, many individuals can achieve significant relief and maintain independence.

Whether seizures occur before, during, or after brain tumor treatment, timely intervention and consistent follow-up can make a profound difference. For patients and caregivers alike, understanding BTRE equips them to face this challenge with confidence, stability, and hope.