Abstract：
OBJECTIVE: To evaluate the incidence and the independent risk factors of SRS-related epilepsy in patients with supratentorial brain metastases (st-BMs), providing evidences for prevention or reduction secondary epilepsy after SRS.
METHODS: Patients with st-BMs from four gamma knife centers who developed secondary epilepsy after SRS were retrospectively studied between January 1, 2017 and June 31, 2023. The incidence and clinical characteristics of the patients with secondary epilepsy were analyzed. The predictive role of baseline clinical-demographic variables was evaluated according to univariate and multivariate logistic regression model. The impact of secondary epilepsy on patients\' OS was evaluated as well by log-rank test.
RESULTS: 11.3 % (126/1120) of the patients with totally 158 st-BMs experienced secondary epilepsy after SRS in median 21 days. 61.9 % (78/126) of the patients experienced simple partial seizures. 91.3 % (115/126) patients achieved good seizure control after received 1-2 kinds of AEDs for median 90 days, while 7.1 % (9/126) of the patients suffered from refractory epilepsy. Patients had higher risk of secondary epilepsy if the tumor located in cortex and/or hippocampus, peri-tumor edema larger than 20.3 cm3 before SRS, had epilepsy history, and failed to receive bevacizumab prior to SRS. There was no difference in the OS of patients who experience secondary epilepsy or not after SRS.
CONCLUSIONS: The incidence of SRS-related secondary epilepsy is 11.3 % in patients with st-BMs in this retrospective study. The risk of secondary epilepsy is higher in patients with st-BM located in cortex and/or hippocampus area, peri-tumor edema larger than 20.3 cm3 before SRS, and epilepsy history. Bevacizumab is suggested prior to SRS therapy, as it could be used for the control of peri-tumor edema and SRS-related damage, hence reduce the risk of secondary epilepsy. However, whether or not patients suffered from secondary epilepsy after SRS does not affect their OS.
METHODS: Patients with st-BMs from four gamma knife centers who developed secondary epilepsy after SRS were retrospectively studied between January 1, 2017 and June 31, 2023. The incidence and clinical characteristics of the patients with secondary epilepsy were analyzed. The predictive role of baseline clinical-demographic variables was evaluated according to univariate and multivariate logistic regression model. The impact of secondary epilepsy on patients\' OS was evaluated as well by log-rank test.
RESULTS: 11.3 % (126/1120) of the patients with totally 158 st-BMs experienced secondary epilepsy after SRS in median 21 days. 61.9 % (78/126) of the patients experienced simple partial seizures. 91.3 % (115/126) patients achieved good seizure control after received 1-2 kinds of AEDs for median 90 days, while 7.1 % (9/126) of the patients suffered from refractory epilepsy. Patients had higher risk of secondary epilepsy if the tumor located in cortex and/or hippocampus, peri-tumor edema larger than 20.3 cm3 before SRS, had epilepsy history, and failed to receive bevacizumab prior to SRS. There was no difference in the OS of patients who experience secondary epilepsy or not after SRS.
CONCLUSIONS: The incidence of SRS-related secondary epilepsy is 11.3 % in patients with st-BMs in this retrospective study. The risk of secondary epilepsy is higher in patients with st-BM located in cortex and/or hippocampus area, peri-tumor edema larger than 20.3 cm3 before SRS, and epilepsy history. Bevacizumab is suggested prior to SRS therapy, as it could be used for the control of peri-tumor edema and SRS-related damage, hence reduce the risk of secondary epilepsy. However, whether or not patients suffered from secondary epilepsy after SRS does not affect their OS.
摘要：
目的：评估幕上脑转移（st-BMs）患者SRS相关癫痫的发生率及其独立危险因素。为SRS后继发性癫痫的预防或减少提供证据。
方法：在2017年1月1日至2023年6月31日之间对来自四个伽玛刀中心的st-BM患者进行了回顾性研究，这些患者在SRS后发生继发性癫痫。分析继发性癫痫的发病情况及临床特点。根据单变量和多变量逻辑回归模型评估基线临床人口统计学变量的预测作用。继发性癫痫对患者OS的影响也通过对数秩检验进行评估。
结果：11.3％（126/1120）的158例st-BMs患者在平均21天的SRS后出现继发性癫痫。61.9%(78/126)的患者出现单纯部分性癫痫发作。91.3%(115/126)的患者在接受1-2种AEDs治疗后中位90天癫痫发作控制良好,7.1%(9/126)的患者患有难治性癫痫。如果肿瘤位于皮质和/或海马区，患者发生继发性癫痫的风险更高，SRS前肿瘤周围水肿大于20.3cm3，有癫痫史,并且在SRS之前未能接受贝伐单抗。SRS后是否经历继发性癫痫的患者的OS没有差异。
结论：在这项回顾性研究中，在st-BM患者中，SRS相关继发性癫痫的发生率为11.3%。位于皮质和/或海马区的st-BM患者发生继发性癫痫的风险较高，SRS前肿瘤周围水肿大于20.3cm3，和癫痫病史。在SRS治疗之前建议贝伐单抗，因为它可以用于控制肿瘤周围水肿和SRS相关的损伤，从而降低继发性癫痫的风险。然而,SRS后患者是否患有继发性癫痫并不影响其OS.
方法：在2017年1月1日至2023年6月31日之间对来自四个伽玛刀中心的st-BM患者进行了回顾性研究，这些患者在SRS后发生继发性癫痫。分析继发性癫痫的发病情况及临床特点。根据单变量和多变量逻辑回归模型评估基线临床人口统计学变量的预测作用。继发性癫痫对患者OS的影响也通过对数秩检验进行评估。
结果：11.3％（126/1120）的158例st-BMs患者在平均21天的SRS后出现继发性癫痫。61.9%(78/126)的患者出现单纯部分性癫痫发作。91.3%(115/126)的患者在接受1-2种AEDs治疗后中位90天癫痫发作控制良好,7.1%(9/126)的患者患有难治性癫痫。如果肿瘤位于皮质和/或海马区，患者发生继发性癫痫的风险更高，SRS前肿瘤周围水肿大于20.3cm3，有癫痫史,并且在SRS之前未能接受贝伐单抗。SRS后是否经历继发性癫痫的患者的OS没有差异。
结论：在这项回顾性研究中，在st-BM患者中，SRS相关继发性癫痫的发生率为11.3%。位于皮质和/或海马区的st-BM患者发生继发性癫痫的风险较高，SRS前肿瘤周围水肿大于20.3cm3，和癫痫病史。在SRS治疗之前建议贝伐单抗，因为它可以用于控制肿瘤周围水肿和SRS相关的损伤，从而降低继发性癫痫的风险。然而,SRS后患者是否患有继发性癫痫并不影响其OS.
