For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?

This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use of anti-seizure medications for patients with brain metastasis without a history of seizures.

There are several important recent studies on this topic:

The first is an important clinical guideline on this subject that is a quick and easy read summarizing data from Walbert et al., PMID 34174071. Here are the key recommendations:

1. Anti-seizure medication does NOT reduce the risk of seizure in metastatic or primary brain tumor patients without a histo...