Seizures in Patients With Metastatic Brain Tumors: Prevalence, Clinical Characteristics, and Features on EEG

Shaun Ajinkya, Jonah Fox, Peter Houston, Adam Greenblatt, Alain Lekoubou, Scott Lindhorst, David Cachia, Adriana Olar, Ekrem Kutluay

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

INTRODUCTION: Metastases to the brain (MB) occur in up to 30% of adults with cancer; of these, 15% to 35% may have seizures. We investigated clinical and pathologic associations with seizure and EEG findings in patients with MB, given the sparse literature in this area. METHODS: We performed a retrospective chart review of adults with pathologically confirmed MB treated at a large tertiary care center between April 8, 2006, and December 14, 2018. Primary outcomes were odds of "chart-documented seizure" (CDS) in the full sample and EEG-captured seizure or any epileptiform discharges among those monitored on EEG. RESULTS: We studied 187 patients with MB, of whom 55 (28.3%) were monitored on EEG. We found an overall CDS prevalence of 29.4% and an EEG-captured seizure of 18.9% among patients monitored on EEG. Of those monitored on EEG, 47.2% had epileptiform discharges. Adenocarcinoma pathology was associated with lower odds of CDS (odds ratio [OR] 0.50, 95% CI 0.26-0.96) and EEG-captured seizure (OR 0.09, 95% CI 0.01-0.87) versus other pathologies. When modeled separately, melanoma pathology was associated with CDS (OR 4.45, 95% CI 1.58-12.57) versus other pathologies. Hemorrhagic MB were associated with any epileptiform discharges (OR 5.50, 95% CI 1.65-18.37), regardless of pathology modeled. Increasing size of the largest dimension of the largest MB was associated with lower odds of CDS (OR 0.68, 95% CI 0.52-0.89 when adenocarcinoma modeled, OR 0.69, 95% CI 0.53-0.91 when melanoma modeled). CONCLUSIONS: Seizures and epileptiform discharges are common in patients with MB. Tumor size and pathology were significantly associated with CDS. Larger studies are needed for further analysis.

Original languageEnglish (US)
Pages (from-to)143-148
Number of pages6
JournalJournal of clinical neurophysiology : official publication of the American Electroencephalographic Society
Volume38
Issue number2
DOIs
StatePublished - Mar 1 2021

All Science Journal Classification (ASJC) codes

  • Physiology
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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