Elevated Seizure and Status Epilepticus Incidence at End-of-Life in Brain Tumor Patients
Overview
This retrospective study found a high incidence of seizures and status epilepticus in patients with primary and secondary brain tumors during the last 45 days of life. Clinical observation combined with routine EEG monitoring revealed that seizures are more frequent at end-of-life than previously reported.
Background
Seizures are a common symptom in patients with primary brain tumors and brain metastases, often being the initial presenting symptom. The risk of epilepsy in these patients ranges widely, with primary brain tumors posing a higher risk than metastases. Diagnosing seizures, especially non-convulsive status epilepticus, is challenging and often under-recognized, particularly in the end-of-life phase where symptom burden is high. Previous studies have reported seizure incidences ranging from 6 to 56% near end-of-life, but these were limited by study settings and methodologies.
Data Highlights
Characteristic
Value
Number of patients included
68
Primary brain tumor patients
40 (58.8%)
Brain metastasis or meningiosis carcinomatosa/lymphomatosa
28 (41.2%)
Patients with prior structural epilepsy diagnosis
58.8%
Average days from admission to death
16.8 (SD 12.2, range 1–50)
Patients admitted for seizures or status epilepticus
32.4%
Key Findings
Seizures are a frequent symptom at end-of-life in brain tumor patients, exceeding previously reported rates.
58.8% of patients had a prior diagnosis of structural epilepsy before admission.
Routine EEG was performed in 72.3% of patients within 45 days prior to death, facilitating detection of subclinical seizures.
Clinical signs of seizures were defined strictly, excluding reduced awareness alone to differentiate from encephalopathy.
Patients were admitted on average 16.8 days before death, with seizures or status epilepticus being a common cause for admission (32.4%).
Exclusion of patients with solely infratentorial tumors ensured focus on supratentorial epileptogenic lesions.
Clinical Implications
Clinicians should maintain a high index of suspicion for seizures and status epilepticus in brain tumor patients nearing end-of-life, even when clinical signs are subtle. Routine EEG monitoring can aid in detecting non-convulsive seizures that may otherwise be missed, allowing for appropriate management to reduce symptom burden. Careful differentiation between encephalopathy and seizure activity is essential for optimal end-of-life care.
Conclusion
This study highlights an elevated incidence of seizures and status epilepticus in the final weeks of life among patients with primary and secondary brain tumors, underscoring the need for vigilant neurological assessment and EEG monitoring in this vulnerable population.
References
Referenced studies [1-21] as cited in source article
