How are seizures treated in brain metastasis?

Updated: Aug 01, 2018
  • Author: Victor Tse, MD, PhD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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The frequency of seizures in patients with metastatic brain tumor is 30-40%. One half of patients who have seizures present with them.

The type of seizure guides treatment. Prophylactic treatment for seizure is not necessary in patients with no history of seizure.

The most commonly used drug is phenytoin, especially for patients with generalized motor seizures. Valproate has also been used, as have newer medications, such as levetiracetam. Phenytoin should be started before radiation therapy. The incidence of allergic reaction increases if it is started after radiation. An allergic reaction can be acute or delayed; it commonly appears within 3-6 weeks after the patient has started the medication.

Status epilepticus occurs infrequently in patients with metastasis, but it is associated with a high mortality rate (6-35%). Status epilepticus should be considered the cause in patients with a prolong postictal state or in stuporous or comatose patients whose imaging study does not show significant mass effect of edema. Status epilepticus should be treated aggressively. Ativan or Diazepam is the common medication. Propofol infusion has also been used.

See the following Medscape Reference articles for more information about the diagnosis and treatment of seizures: Complex Partial Seizures and Status Epilepticus.

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