Seizure Burden and Antiepileptic Drug Utilization in Brain Tumor Patients

Abstract

Seizures are a common neurological complication of pediatric brain tumors and contribute significantly to morbidity and impaired quality of life. The burden of tumor-associated seizures and patterns of antiepileptic drug (AED) utilization in children remains variable and incompletely characterized, particularly in low-resource settings. This study was conducted to evaluate seizure prevalence, AED utilization patterns, and changes in AED requirements before and after surgical treatment in pediatric patients with brain tumors. This retrospective cohort study included 53 pediatric patients (≤16 years) with brain tumors who underwent neurosurgical intervention at a specialized pediatric neurology center in Tripoli, Libya. Clinical data were extracted from medical records, including demographic characteristics, tumor location, histopathology, WHO tumor grade, seizure presence and type, and AED use before and after surgery. Seizure types were classified according to International League Against Epilepsy criteria. Early postoperative AED response was defined as seizure freedom during the first postoperative week without escalation of therapy. Descriptive statistics were used, and paired comparisons of AED requirements before and after surgery were analyzed using the McNemar test. The mean age at diagnosis was 9.23 ± 4.9 years, and 77.4% of patients were male. Tumors were predominantly supratentorial in 65.4% of cases. Seizures were present at presentation in 15.1% of patients. AED therapy was prescribed in 84.9% of patients, most commonly phenytoin. Seizure prevalence was higher among patients with supratentorial tumors and low-grade gliomas compared with infratentorial and high-grade tumors (p = 0.028). Surgical intervention was associated with improved early postoperative seizure control and reduced need for AED escalation. No seizures were documented among patients who received radiotherapy or chemotherapy at presentation. Seizure prevalence in this pediatric brain tumor cohort was relatively low; however, AED utilization was high, reflecting common prophylactic prescribing practices. Seizure burden and AED response varied according to tumor location and grade. These findings highlight the importance of individualized seizure management strategies and the need for prospective studies to optimize AED use in pediatric neuro-oncology.