Short summary

To identify variables associated with the development of pre- and postoperative seizures in patients who underwent surgical resection of cerebral metastasis, in a patient cohort not routinely treated prophylactically with antiepileptic drugs (AED).

Rationale

Brain metastasis are the most common type of brain tumor in adults. The overall prognosis of patients with brain metastasis is poor with the median survival of approximately 6-12 months despite advances in cancer therapies. Approximately 20-40% of patients with primary cancers develop brain metastases. Preoperative seizures are most common presenting symptoms and present in up to 20% of brain metastasis. Seizures are one of the major cause of morbidity and mortality and is one of the common complications in these patients before and after the neurosurgical treatment. The care and management of these patient can be influenced by identifying significant risk factors for pre- and postoperative seizures, thus improving the quality of life. There are only a few publications that have examined the associations between incidence of pre- and postoperative seizures among patients with brain metastases. Seizures are also particularly concerning because anti-epileptic medications can impact quality of life and interfere with chemotherapeutic regimens. The use of prophylactic antiepileptic drugs is still controversial. There is not enough evidence suggesting the positive effect of administration of prophylactic AEDs in preventing seizures, but on the contrary, it may have unfavorable neurocognitive side effects. Since prophylactic AEDs is not used in Denmark it gives us the unique possibility to perform such studies. In this retrospective cohort study, we examine variables such as clinical characteristics, neuroimaging, and precise tumor pathology in patients surgically treated for cerebral metastasis and not routinely treated prophylactically with AEDs at the Neurosurgical department, Odense University Hospital (OUH) from 2007 to 2015.

The goal of this study is to characterize the demographic information and epidemiology of seizure among patients with metastatic brain tumors before and after neurosurgical intervention, to identify related risk factors for development of pre- and postoperative seizures in patients surgically treated for cerebral metastasis, determine the effect of surgery on seizure control, and identify the optimal management of seizures. Our retrospective study includes patients who have received any number of surgical operations for resection of metastatic brain tumors and those who have undergone radiation therapy or chemotherapy in addition to surgery.

Description of the cohort

Retrospective cohort study of the patients who underwent resection of cerebral metastasis at the Neurosurgical department in Odense University Hospital (OUH) between 2007-2015. Patients will be identified via the ICD code DC793 in the national patient record database system. All clinical data available for each patient will be collected from COSMIC and then managed using REDCap electronic data capture tools. Inclusion criteria are cerebral metastasis (DC793), surgical resection of a cerebral metastasis within the requested study period, and sufficient documentation in the medical records with adequate pathology and radiology reports.

Data and biological material

Patients will be identified via the ICD code DC793 in the national patient record database system, and all their medical records and MR scans will be reviewed.

The project is approved by The Danish Data Protection Agency and Danish Health Authority. According to Danish legislation individual patient consent was not necessary.

Collaborating researchers and departments

Department of Neurosurgery, Odense University Hospital (OUH)

• Professor Frantz Rom Rom Poulsen, MD, PhD
• Christian Bonde Pedersen, MD, PhD
• Pushpa Raj Puri, MD 

Clinical Institute, University of Southern Denmark, Odense, Denmark

• Jian Fernandes Seyedi, Stud. Med.

Publications associated with the project

Risk of seizures before and after neurosurgical treatment of intracranial meningiomas. Seyedi JF,  Pedersen CB,  Poulsen FR. Clin Neurol Neurosurg. 2018 Jan 5;165:60-66. doi: 10.1016/j.clineuro.2018.01.002.