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Seizure Risk in Patients With Brain Metastases: Interim Analysis From a Prospective Observational Study. Is it Time
J de Boisanger1, J Konadu2, A Tran2
1The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
Seizures after stereotactic radiosurgery for brain metastases occur at a rate below 20%, decreasing over time. This prospective study offers new insights into seizure risk for patients with brain metastases.
Area of Science:
- Neurology
- Neurosurgery
- Oncology
Background:
- Seizures are a frequent complication of brain metastases (BMs), leading to prolonged driving bans in the UK based on an estimated risk of 20% or higher.
- Current driving regulations are based on outdated and heterogeneous retrospective studies regarding seizure risk in patients with BMs.
Purpose of the Study:
- To prospectively evaluate the seizure rate in patients with BMs following stereotactic radiosurgery (SRS).
- To determine if the post-SRS seizure rate is below the 20% threshold that informs UK driving regulations.
Main Methods:
- An interim analysis of the SAFER study included the first 75 patients undergoing SRS for BMs.
- The primary endpoint was the post-SRS seizure rate, assessed using an exact two-sided binomial test (alpha=0.05).
Main Results:
- The overall post-SRS seizure incidence was 10.7% (95% CI 4.7-19.9%).
- The cumulative incidence, accounting for mortality, was also 10.7% (95% CI 5.0-18.8%).
- The new-onset seizure rate was 9.2% (95% CI 3.5-19.0%), with a 5.8% risk by 12 months for those seizure-free at 6 months.
Conclusions:
- This is the first prospective study to assess seizure rates as a primary endpoint in patients with BMs treated with SRS.
- The observed seizure rate is significantly lower than 20% and diminishes over time.
- Findings may influence patient/clinician perceptions of seizure risk and UK driving regulations for individuals with BMs treated by SRS.
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