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Peer-reviewedCC BY 4.0Clinical Medicine

Management of epilepsy in the brain tumour patient: Current concepts and practical approaches

  • Jeremy Rees1,2,3
  1. 1Department of Neurology, Shaarei Zedek Medical Center, Jerusalem, Israel
  2. 2National Hospital for Neurology and Neurosurgery, Queen Square and Cleveland Clinic London, United Kingdom
  3. 3Queen Square Institute of Neurology, University College London, United Kingdom
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Abstract

Brain tumour-related epilepsy (BTRE) is among the most common, disabling and feared complications of primary and metastatic brain tumours. Seizures cause significant suffering, psychosocial burden, reduced quality of life and lead inevitably to the loss of a driving license. The mechanisms underlying BTRE are multifactorial, including tumour-driven alterations in neuronal excitability and pro-epileptogenic metabolites. Management is more challenging than idiopathic epilepsy due to high rates of drug resistance, the natural history of brain tumours and potential interactions between anti-seizure medications (ASMs) and chemotherapy/steroids. This review summarises the pathophysiology of BTRE, outlines risk factors, and provides practical recommendations for ASM selection, prophylaxis, withdrawal, and the role of surgery, radiotherapy, chemotherapy, and neuromodulation. Updated clinical evidence supports the use of non-enzyme-inducing ASMs as first line treatment as these do not interact with chemotherapy/steroids and are better tolerated than the first generation ASMs. ASM prophylaxis is not recommended and ASM withdrawal, particularly in patients with gliomas, should be made only after careful consideration of the patient's seizure history and the stability of their disease.

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Cite

BibTeXRIS
BibTeX
@article{rees2026management,
  title = {{Management of epilepsy in the brain tumour patient: Current concepts and practical approaches}},
  author = {Jeremy Rees},
  journal = {Clinical Medicine},
  year = {2026},
  month = sep,
  doi = {10.1016/j.clinme.2026.100650},
  url = {https://doi.org/10.1016/j.clinme.2026.100650},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Management of epilepsy in the brain tumour patient: Current concepts and practical approaches
AU  - Jeremy Rees
PY  - 2026
DA  - 2026/09/28
JO  - Clinical Medicine
DO  - 10.1016/j.clinme.2026.100650
UR  - https://doi.org/10.1016/j.clinme.2026.100650
AB  - Brain tumour-related epilepsy (BTRE) is among the most common, disabling and feared complications of primary and metastatic brain tumours. Seizures cause significant suffering, psychosocial burden, reduced quality of life and lead inevitably to the loss of a driving license. The mechanisms underlying BTRE are multifactorial, including tumour-driven alterations in neuronal excitability and pro-epileptogenic metabolites. Management is more challenging than idiopathic epilepsy due to high rates of drug resistance, the natural history of brain tumours and potential interactions between anti-seizure medications (ASMs) and chemotherapy/steroids. This review summarises the pathophysiology of BTRE, outlines risk factors, and provides practical recommendations for ASM selection, prophylaxis, withdrawal, and the role of surgery, radiotherapy, chemotherapy, and neuromodulation. Updated clinical evidence supports the use of non-enzyme-inducing ASMs as first line treatment as these do not interact with chemotherapy/steroids and are better tolerated than the first generation ASMs. ASM prophylaxis is not recommended and ASM withdrawal, particularly in patients with gliomas, should be made only after careful consideration of the patient's seizure history and the stability of their disease.
SN  - 1470-2118
SN  - 1473-4893
ER  -