Prevalence of Seizures among Neurosurgical Outpatients at Tertiary Care Center in Northern India: Emphasis on Brain Tumors, Correlation with Tumor Pathology, and Management

Abstract To assess the prevalence of seizures in neurosurgery outpatient department (OPD) patients at All India Institute of Medical Sciences (AIIMS) Jammu, with emphasis on those presenting with brain tumors. We evaluated pathological correlations, anatomical risk factors, and comprehensive management strategies, including long-term functional outcomes. This was a cross-sectional observational study conducted at the neurosurgery OPD of AIIMS Jammu over 12 months (August 2024–July 2025). Inclusion criteria comprised adult and pediatric patients presenting with new-onset seizures and/or intracranial tumor diagnosis. Statistical analysis included prevalence calculation with 95% confidence intervals (CIs), chi-square or Fisher's exact tests for categorical variables, multivariate logistic regression for seizure predictors, and functional outcome assessment using modified Rankin scale (mRS) and Quality of Life in Epilepsy-31 (QOLIE-31) scores. Of 2,800 neurosurgical outpatients screened, 212 (7.6%; 95% CI 6.6–8.6%) presented with seizures. Sixty-five patients (30.7% of seizure cohort) had confirmed intracranial tumors, with 29 of 65 (45%; 95% CI 33.4–56.7%) presenting with seizures as initial manifestation. Mean age for the overall cohort was 42.3 ± 15.7 years, with a pediatric (<18 years) subgroup comprising 8.5% of all patients (238/2,800) and 12.3% of tumor-seizure patients (8/65). Focal seizures were more common than generalized seizures (53 vs. 47%). Tumor pathology significantly influenced seizure occurrence: gliomas 55.3% (36/65), meningiomas 18.5% (12/65), dysembryoplastic neuroepithelial tumors and gangliogliomas 10.7% (7/65), metastases 9.2% (6/65), and pituitary adenomas 6.2% (4/65). Anatomically, temporal lobe tumors (36.9%, n = 24) and frontal lobe tumors (27.7%, n = 18) carried the highest seizure risk. Of temporal lesions (n = 24), 16 (66.7%) were in cortically eloquent regions involving superficial cortex; 10 demonstrated peritumoral edema. Laterality analysis showed right-sided lesions in 54.2% (13/24) and left-sided in 45.8% (11/24) of temporal cases. Multilobar involvement occurred in 8 of 65 patients (12.3%), predominantly in high-grade gliomas. Multivariate analysis identified tumor location (temporal/frontal), low-grade histology, and peritumoral edema as significant predictors (p < 0.05); the 95% CI for odds ratios of low-grade tumors was 2.1–9.3. Follow-up at 12 months demonstrated seizure freedom in 127 of 212 patients (60%) with functional improvement: mRS improved or remained stable in 168 of 180 patients (93.3%), and QOLIE-31 scores improved from median 58 (IQR 42–72) at baseline to 71 (IQR 61–80) in seizure-free cohort (p < 0.001). Seizures represent a common and significant complication in brain tumor patients, particularly those with low-grade gliomas and temporal or frontal lobe location. Pathology-specific and anatomically informed management strategies, combined with comprehensive functional assessment, improve seizure outcomes and quality of life in this population.