Impact of Anti-Seizure Medication Duration on Postoperative Seizures Following Supratentorial High-Grade Glioma Resection: A Mixed-Model and Tree-Based Approach Publisher Pubmed



Amirkhani N ; Maroufi F ; Pourrashidi A ; Shirani M ; Chandler JP
Source: Journal of Neuro-Oncology Published:2026

Abstract

Purpose: Postoperative seizures are a significant complication following glioma surgery. While prophylactic antiseizure medications (ASMs) are widely prescribed, the optimal duration of prophylaxis remains unclear. Current guidelines lack specificity regarding high-risk subgroups that may benefit from extended ASM therapy. Here, we aimed to determine whether ASM duration affects postoperative seizure occurrence and to identify patient subgroups in whom longer ASM prophylaxis significantly reduces seizure risk. Methods: We conducted a retrospective cohort study of 206 adult high-grade glioma patients who underwent resection. Postoperative seizure occurrence was the primary outcome. ASM duration was modeled using logistic regression with cubic splines to detect non-linear effects, and a classification decision tree was trained to identify high-risk subgroups. Observed seizure rates were compared across data-driven ASM duration thresholds. Time-to-event analysis was also performed. Results: Mean age was 48.1 years (SD 15.9); 48.5% were male. Most tumors were located in the frontal (43.3%) and temporal lobes (29.6%), with glioblastoma being the most common histology (65%). Spline regression revealed no statistically significant association between ASM duration and seizure occurrence (pseudo R² = 0.0066; p = 0.69). However, decision tree analysis suggested a clinically meaningful subgroup: patients aged > 52.5 years with subtotal resection had increased seizure risk when ASM duration was ≤ 135 days. In this group, extending ASM prophylaxis was associated with a lower seizure rate. Conclusion: While extended ASM prophylaxis was not broadly associated with reduced seizure risk, tree-based analysis suggested an older, incompletely resected subgroup that may benefit from prolonged ASM use. Registration number: IR.TUMS.SINAHOSPITAL.REC.1402.091 retrospectively registered. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.