Seizure Characteristics in Epilepsy Patients with a Primary Brain Tumor

Purpose: Epilepsy is among the most prevalent neurological disorders, with one in 20 people experiencing a seizure in their lifetime. In adults, brain tumors are a common cause. While tumor-control outcomes are well studied, less is known about seizure control in this population. Methods: We retrospectively reviewed the Clalit Dan-Petah Tikva County database (2000–2019) to identify adults with tumor-related epilepsy and assess seizure control rates. Results: Among 1,557,764 individuals, 17,225 (1.1%) adults were diagnosed with a brain tumor, of whom 14.7% (n=2,532) had secondary epilepsy. Glioma patients had more than double the epilepsy rate (29.2%, n=878) compared to meningioma (13.1%, n=1,417). Most patients with tumor-related epilepsy had benign tumors (65.6%, n=1,661), while 34.4% (n=871) had malignant tumors. Overall, 9.7% (n=1,672) were classified as high-risk for drug-resistant epilepsy (DRE), yet only 0.5% (n=89) carried an official DRE diagnosis. Of these 1,672 patients, just 12 (0.7%) received follow-up at a specialized epilepsy clinic; the remainder were managed by community neurologists, oncologists, neurosurgeons, or primary care physicians. None of the patients with intractable epilepsy underwent evaluation for epilepsy surgery. Conclusion: Despite adequate tumor control, many patients with tumor-related epilepsy continue to experience seizures after resection and oncological treatment, either due to suboptimal management or true intractability. Under-recognition of DRE and low referral rates to specialized epilepsy centers highlight a significant treatment gap. Improved referral pathways and comprehensive evaluations are needed to optimize seizure outcomes in this population.