The need for seizure prophylaxis for patients with brain tumors who have not developed epilepsy is controversial. Overall, studies have found no significant difference in development of late seizures between patients receiving and not receiving antiepileptic drug (AED) prophylaxis, suggesting that AEDs do not prevent epileptogenesis.81–84 Potential AED side effects and the possibility that patients may remain seizure-free without treatment may weigh against prophylactic AED therapy. A recent practice parameter by the American Academy of Neurology recommends against AED prophylaxis in patients with newly diagnosed brain tumors, since it is not effective in preventing seizures.85

The evidence regarding perioperative AED prophylaxis is less conclusive. Postoperative seizures occur most often in the first week to first month postsurgery, for patients both with and without tumors.86,87 Although many patients with brain tumors receive AED prophylaxis in the perioperative period, no definite benefit has been demonstrated.82,85 Patients with brain tumors are often given prophylactic AEDs to avoid ictal complications in the perioperative period, but there is no controlled evidence that perioperative AED prophylaxis is effective.83,85,88 If patients are treated perioperatively, tapering and discontinuation of the AEDs after the first postoperative week is recommended.85

Adapted from: Mangano FT, McBride AE, and Schneider SJ. Brain tumors and epilepsy. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;175–194. 
With permission from Elsevier (www.elsevier.com). 

Authored By: 
Steven C. Schachter, MD
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Authored Date: 
03/2004