Management of Seizures in Brain Metastases

Managing epilepsy is integral to diagnosing and treating patients with brain metastases from various systemic malignancies. Seizures are a common symptom in this vulnerable patient population, who often require neurological expertise in conjunction with their oncological care. It is crucial to understand the etiology and diagnostic workup of seizures before formulating an appropriate treatment plan. This chapter provides an overview of seizures in patients with brain metastases, discussing the efficacy of several antiepileptic drugs (AEDs) and the need to balance their respective side effect profiles and interactions with various chemotherapies. In addition to exploring the role of surgery and radiation and their effects on seizure control, we also expand on other important clinical considerations in patients with seizures, including driving restrictions, prophylaxis, and care at the end of life.