Objective: Understanding the prevalence and impact of epileptic seizures in patients with brain metastases is crucial, yet remains inadequately explored. This study aims to investigate the frequency of seizures in this cohort and assess the efficacy of treatments for brain metastases in mitigating seizure occurrence. Additionally, it seeks to evaluate the consistency of seizure evaluation practices at the initial diagnosis of brain metastases, aiming to enhance patient care and outcomes.

Methods: In this retrospective monocentric cohort study, data was analysed from 291 consecutive patients diagnosed with brain metastases from solid tumors. These patients underwent either tumor resection and/or radiation therapy between September 2015 and September 2023.

Results: More than half of all patients (median age 64 yrs, range 30-86, 51% male) harboured brain metastasis from lung cancer and 23% experienced at least one seizure. First line treatment was Levetiracetam in most patients (90%). Whole-brain radiation was applied in139 patients, 200 received stereotactic radiosurgery for brain metastases, and 27 underwent hippocampal sparing radiation therapy. Resection of brain metastasis was done in 30% of the patients. Interestingly, there was no standardized evaluation of seizures in more than ¾ of the patients with brain metastasis in the initial diagnostic work up.

Conclusion: More than 20% of the patients in our retrospective monocentric study experienced at least one seizure. The origin of brain metastasis in our cohort was lung cancer in most cases. It can be assumed that the number of unreported cases is higher and that a systematic evaluation will further increase the incidence. Taken into account that epileptic seizures are a strong and additional negative factor for the overall quality of life of cancer patients, this data shows the urgent need of further research and the development of interventions to improve the outcome of these patients.