Treatment Considerations in Tumor-Related Epilepsy

Tumor-related epilepsy (TRE) is among the most common and disabling complications of brain tumors, affecting approximately 40% of patients over the course of the disease. Seizures may be the initial manifestation of a tumor, emerge during treatment, or recur with progression, each carrying distinct prognostic and therapeutic implications. This review synthesizes current understanding of TRE epidemiology and highlights contemporary treatment strategies, with a focus on how anti-seizure medications (ASMs), surgery, radiation, chemotherapy, and targeted therapies should be used when considering seizure control. Special attention is also given to the prevention of treatment-related complications and managing the impact of TRE on quality of life (QOL).

Epidemiological studies underscore the heterogeneity of TRE, with seizure prevalence highest in long-term epilepsy-associated tumors (LEATs) and IDH-mutant gliomas, and lowest in metastases, posterior fossa tumors, and lymphoma. Gross total resection provides the most durable seizure control, particularly in lower grade tumors, while radiation and chemotherapy confer additional benefit through suppression of tumor growth. IDH inhibitors, such as vorasidenib, have recently demonstrated improved progression-free survival in IDH-mutant gliomas and may represent a promising avenue for seizure reduction, although definitive evidence is pending. Advances in minimally invasive surgical techniques, cognitive rehabilitation programs, and patient-reported outcome measures further expand the scope of TRE management and highlight the value of interprofessional care for these patients.

Management of TRE requires a multidisciplinary approach that balances tumor control, seizure suppression, and preservation of QOL. While ASMs remain first-line, surgery, adjuvant therapies, and emerging molecularly targeted treatments are essential in achieving seizure control and improving outcomes. Preventing complications, minimizing drug–drug interactions, and optimizing QOL are central to patient-centered treatment.