The Prevalence of Seizures in Brain Metastasis Patients on Anticonvulsant Prophylaxis: A Systematic Review and Meta-Analysis

INTRODUCTION:Brain metastasis (BM) prognosis is incredibly poor and is often associated with considerable morbidity. Seizures are commonly present in these patients, and their biopsychosocial impact can be dangerous. The use of Anti-epileptic drugs (AED) as primary prophylaxis remains controversial. This systematic review and meta-analysis aim to evaluate the efficacy of AED prophylaxis in patients with brain metastasis. METHODS:MEDLINE via PubMed, Web of Science, EMBASE, and Cochrane were searched for articles pertinent to AED prophylaxis use in patients with BM. BM patients previously treated for cancer who were seizure naive at the time of inclusion were included. Data regarding patient characteristics, type of AED, prior treatments, and groups at a high risk of seizure were extracted. Seizure prevalence was obtained. RESULTS:1,902 total BM patients were included, with 381 receiving antiepileptic prophylaxis, and 1,521 receiving no prophylaxis. In the compiled study subpopulations, seizures were present in 21% of patients receiving prophylaxis and 20% of patients in the control arms. Meta-analyses estimated seizure prevalence in the control and treatment groups to be 18% (CI: 0.10 - 0.29) and 17% (CI: 0.10 - 0.28), respectively. Effect size comparison of seizure prevalence between the two subgroups yielded no significant difference. CONCLUSIONS:Seizure prevalence was not significantly different in populations on anti-epileptic prophylaxis versus control. Treatment modalities such as prompt surgical resection or radiotherapy, continue to serve as the main methods of seizure control in this population.