Seizures in Brain Tumour

Epileptic seizures are among the most common and disabling symptoms in patients with brain tumours, especially gliomas, often severely impacting quality of life and complicating oncologic management. This review synthesizes current evidence on brain tumour–related epilepsy (BTRE) treatment, focusing on antiseizure medication (ASM) choices, withdrawal timing, and surgical outcomes. A systematic search of PubMed and Google Scholar (2015–2025) identified five high-quality studies. Data show that seizure recurrence after ASM withdrawal remains significant, with up to 47% relapsing within three years, even after extended seizure-free periods. Comparative studies indicate that levetiracetam is associated with lower treatment failure rates than valproic acid, mainly due to fewer uncontrolled seizures, although both drugs have notable side effect profiles. Newer-generation ASMs like lacosamide and perampanel demonstrate high responder rates and acceptable tolerability but require monitoring for psychiatric and behavioural effects. Surgical resection remains a cornerstone of treatment, offering long-term seizure freedom for many; over half of patients undergoing surgery successfully withdrew from ASMs altogether. These findings highlight that optimal seizure management in BTRE demands an individualized, multidisciplinary strategy that considers tumour type, seizure risk, drug interactions, and patient preferences. Ultimately, careful ASM selection, timely withdrawal decisions, and integration of surgical interventions are essential to balancing seizure control with maintaining cognitive function and quality of life.