Abstract
Objective: To test the hypothesis that subets of patients with brain metastases (BrM) without seizures at intracranial presentation are at increased risk for developing seizures, we characterized the incidence and risk factors for seizure development among seizure-naïve patients with brain metastases (BrM).
Methods: We identified 15,863 and 1,453 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham and Women’s Hospital/Dana Farber Cancer Institute (2000-2015) institutional data, respectively. Cumulative incidence curves and Fine/Gray’s competing risks regression were used to characterize seizure incidence and risk factors, respectively.
Results: Among SEER-Medicare and institutional patients, 1,588 (10.0%) and 169 (11.6%) developed seizures, respectively. On multivariable regression of the SEER-Medicare cohort, African American vs. White race (hazard ratio [HR]=1.45 [95% CI, 1.22-1.73], p<0.001), urban vs. non-urban residence (HR=1.41 [95% CI, 1.17-1.70], p<0.001), melanoma vs. NSCLC as primary tumor type (HR=1.44 [95% CI, 1.20-1.73], p<0.001), and receipt of brain-directed stereotactic radiation (HR=1.67 [95% CI, 1.44-1.94], p<0.001) were associated with greater seizure risk. On multivariable regression of the institutional cohort, melanoma vs. NSCLC (HR=1.70 [95% CI, 1.09-2.64], p=0.02), >4 BrM at diagnosis (HR=1.60 [95% CI, 1.12-2.29], p=0.01), presence of BrM in a high-risk location (HR=3.62 [95% CI, 1.60-8.18], p=0.002), and lack of local brain-directed therapy (HR=3.08 [95% CI, 1.45-6.52], p=0.003) were associated with greater risk of seizure development.
Conclusions: The role of antiseizure medications among select patients with BrM should be re-explored, particularly for those with melanoma, a greater intracranial disease burden, and/or BrM in high-risk locations.
- Received June 7, 2020.
- Accepted in final form October 28, 2020.
- © 2021 American Academy of Neurology
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