Seizure Risk in Patients with CNS Tumors
Robert M. Taylor, MD FAAN FAAHPM, Amber D. Hartman, PharmD, and Lucretia Long, CNP
Patients with no prior history of epilepsy and no primary central nervous system (CNS) disease rarely experience seizures at the end of life. However, patients with CNS tumors have an increased seizure risk. The risk of seizures is highest for patients with CNS tumors who have had previous seizures, although it may be reduced for patients who have undergone treatment with surgery, radiation, or chemotherapy. Steroids may reduce the risk of seizures by reducing edema, although tapering steroids may increase the risk. Statistically, low-grade primary CNS tumors confer higher risk of seizures than do high-grade tumors. The risk for metastatic CNS tumors is variable.
Multiple studies have demonstrated no clear benefit from prophylactic antiepileptic drug (AED) therapy for patients who have CNS tumors and no prior history of seizures. Therefore, initiating AED prophylaxis is not recommended for such patients, and if a patient is currently receiving an AED, it should be tapered and discontinued.