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Status Epilepticus in Patients With CNS Metastases—Reply

David Schiff, MD; Robert Cavaliere, MD
Arch Neurol. 2007;64(6):916-917. doi:10.1001/archneur.64.6.916-b.
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We appreciate the comments of Drs Blitshteyn and Jaeckle. We share their perception that the outcome is worse with status epilepticus (whether convulsive or nonconvulsive) from intracranial metastases than with primary brain tumors. Several factors may contribute to this. Patients with brain metastases tend to be older than patients with primary brain tumors, and in fact, the most epileptogenic primary brain tumors tend to be low grade and associated with relatively good survival.1 In our series, patients with brain metastases had more acute illnesses thought to be contributing to status epilepticus than did patients with primary brain tumor. Furthermore, patients with leptomeningeal seeding from cancer appear to be highly represented in case series of cancer with status epilepticus,26 and most of these patients have a systemic primary tumor. Finally, brain metastases, particularly leptomeningeal metastases, continue to have a worse overall prognosis than primary brain tumors.

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Status epilepticus in patients with CNS metastases. Arch Neurol 2007;64(6):916; author reply 916-7.