Evidence-Based Recommendations for Seizure Prophylaxis in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery

Arvin R. Wali, Robert C. Rennert, Sonya G. Wang, Clark C. Chen

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations


Symptomatic epilepsy is frequently encountered in patients with brain metastases (BM), affecting up to 25% of them. However, it generally remains unknown whether the risk of seizures in such cases is affected by stereotactic radiosurgery (SRS), which involves highly conformal delivery of high-dose irradiation to the tumor with a minimal effect on adjacent brain tissue. Thus, the role of prophylactic administration of antiepileptic drugs (AED) after SRS remains controversial. A comprehensive review and analysis of the available literature reveals that according to prospective studies, the incidence of seizures after SRS for BM varies from 8% to 22%, and there is no evidence that SRS increases the incidence of symptomatic epilepsy. Therefore, routine prophylactic administration of AED prior to, during, or after SRS in the absence of a seizure history is not recommended. Nevertheless, short-course administration of an AED may be judiciously considered (on the basis of class III evidence) for selected high-risk individuals.

Original languageEnglish (US)
Title of host publicationActa Neurochirurgica, Supplementum
PublisherSpringer Science and Business Media Deutschland GmbH
Number of pages5
StatePublished - 2021

Publication series

NameActa neurochirurgica. Supplement
PublisherSpringer Wien
ISSN (Print)0065-1419

Bibliographical note

Funding Information:
Acknowledgements Dr. Wali was funded through a National Institutes of Health (NIH) TL1 predoctoral grant (#1TL1TR001443).

Publisher Copyright:
© 2021, Springer Nature Switzerland AG.


  • Antiepileptic drugs
  • Fractionated radiotherapy
  • Intracranial metastases
  • Prophylactic antiepileptic therapy
  • Seizures
  • Stereotactic radiosurgery
  • Symptomatic epilepsy
  • Prospective Studies
  • Humans
  • Brain Neoplasms/surgery
  • Radiosurgery
  • Seizures/etiology
  • Retrospective Studies

PubMed: MeSH publication types

  • Review
  • Journal Article


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