Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Prophylactic Anticonvulsants in the Treatment of Adults with Metastatic Brain Tumors

TARGET POPULATIONS: Adults with solid brain metastases who have not experienced a seizure. QUESTION 1: Do prophylactic antiepileptic drugs (AEDs) decrease the risk of seizures in nonsurgical patients with brain metastases who are otherwise seizure-free? RECOMMENDATION: Level 3: Prophylactic AEDs are not recommended for patients with brain metastases who did not undergo surgical resection and are otherwise seizure-free. QUESTION 2: Do prophylactic AEDs decrease the risk of seizures in patients with brain metastases and no prior history of seizures in the postoperative setting? RECOMMENDATION: Level 3: Routine postcraniotomy AED use for seizure-free patients with brain metastases is not recommended. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-treatmentadults-metastatic-brain-tumors/chapter-8.