Clinical Scorecard: Elevated Incidence of Seizures and Status Epilepticus at End-of-Life in Individuals with Primary and Secondary Brain Tumors
At a Glance
Category
Detail
Condition
Seizures and status epilepticus in patients with primary brain tumors and brain metastases at end-of-life
Key Mechanisms
High incidence of epileptic seizures due to tumor-related epileptogenic lesions; challenges in diagnosing non-convulsive status epilepticus (NCSE); disease progression impacting seizure risk
Target Population
Patients with primary brain tumors or brain metastases in the last 45 days of life
Care Setting
Neuro-oncological/epileptologic hybrid ward, palliative care units, hospices, outpatient/home care
Key Highlights
Seizures occur in 30–50% of patients as the first symptom leading to brain tumor diagnosis; epilepsy risk ranges 20–80% in primary brain tumors.
Non-convulsive status epilepticus (NCSE) is underdiagnosed and often subclinical, complicating management at end-of-life.
Incidence of clinically observed seizures at end-of-life ranges widely (6–56%), with this study suggesting higher rates due to specialized monitoring.
Guideline-Based Recommendations
Diagnosis
Use routine EEG with low threshold in neuro-oncological patients at end-of-life to detect clinical and subclinical seizures.
Define clinical seizures per ILAE criteria excluding reduced awareness alone due to difficulty differentiating from encephalopathy.
Apply Salzburg criteria for diagnosis of status epilepticus on EEG.
Management
Recognize seizures and status epilepticus as significant burdens in end-of-life care requiring appropriate treatment.
Consider interdisciplinary neuro-oncological and epileptologic expertise for optimal seizure management in palliative settings.
Monitoring & Follow-up
Implement continuous clinical observation by trained neurologists and nursing staff in neuro-oncological wards.
Perform routine EEGs within 45 days prior to death to monitor seizure activity, especially in patients with prior structural epilepsy.
Risks
High risk of seizures and status epilepticus in patients with progressive or stable supratentorial brain tumors at end-of-life.
Non-convulsive seizures may be missed without EEG monitoring, leading to undertreatment.
Patient & Prescribing Data
Neuro-oncological patients with primary or secondary brain tumors in last 45 days of life
High prevalence of structural epilepsy prior to admission (58.8%) suggests need for ongoing antiseizure therapy; seizure-related admissions common near end-of-life.
Clinical Best Practices
Exclude patients with solely infratentorial tumors from seizure risk assessments due to different pathophysiology.
Use MRI within 3 months prior to death for tumor staging and assessment of disease progression per RANO criteria.
Ensure EEG interpretation by board-certified neurophysiologists with consensus review for ambiguous findings.
Document clinical signs of seizures including aura, motor symptoms, and gaze deviation; do not rely solely on reduced awareness.
Follow up neuro-oncological patients after discharge to record time of death and seizure occurrence.
