Antipsychotics and Seizure Risk in Patients with Brain Tumors: Mechanisms, Modifiers, and Clinical Insights

Area of Science:

• Neuro-oncology
• Neuropsychiatry
• Epileptology

Background:

• Brain tumors cause cortical hyperexcitability, increasing seizure risk.
• Neuropsychiatric symptoms are common and often require antipsychotic treatment.
• Existing antipsychotic seizure liability data often exclude patients with brain tumors.

Purpose of the Study:

• To review the seizure risk associated with antipsychotic use in brain tumor patients.
• To synthesize evidence on tumor-associated hyperexcitability and antipsychotic seizure liability.
• To propose a framework for informed antipsychotic prescribing in neuro-oncology.

Main Methods:

• Literature synthesis of tumor biology, cortical instability, and antipsychotic seizure risk.
• Analysis of clinical modifiers of seizure risk in brain tumor populations.
• Development of a seizure-informed, interdisciplinary prescribing framework.

Main Results:

• Antipsychotic seizure risk is context-dependent in brain tumor patients.
• Clozapine and low-potency first-generation antipsychotics carry the highest seizure risk.
• Risperidone and aripiprazole are associated with lower seizure risk; some antiseizure medications may worsen behavioral symptoms.

Conclusions:

• Antipsychotic selection in neuro-oncology must consider tumor biology and seizure risk.
• An interdisciplinary approach integrating tumor characteristics, antiseizure medication choice, and psychiatric needs is crucial.
• A seizure-informed framework can guide safer antipsychotic prescribing for brain tumor patients.