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Seizures affect 30% of symptomatic preoperative patients and a further 12% of postoperative patients. Although most patients may be cured of their oncological disease by surgery, seizures confer disability, reduced quality\u2010of\u2010life, delayed return to driving and work, and increase the risk of sudden death. Tumor\u2010associated seizures are also more likely to be resistant to antiseizure medications (ASMs). ASMs are limited to treating the symptoms of epilepsy\u2014seizures\u2014but have no disease\u2010modifying effect on the mechanisms that cause or maintain seizure susceptibility. There is a need to be able to predict who is at risk of developing postoperative seizures for targeted prevention or closer monitoring of those at greater risk. Mechanisms underpinning brain tumor\u2013related seizures are most likely multifactorial and related to morphological, biochemical, and metabolic causes. Brain tumors likely cause cortical hyperexcitability due to irritation caused by mass effect, brain invasion, and peritumoral brain edema. Inflammatory mediators are involved in epileptogenesis in animal models and human seizure syndromes and there are experimental data to support the development of inflammatory mediators as biomarkers for epileptogenesis. Meningioma\u2010associated seizures are incompletely understood and consequently unpredictable with current knowledge. In this review, we discuss the proposed mechanisms of epileptogenesis in brain tumors and putative neuroinflammatory mechanisms for meningioma\u2010associated seizures. Ultimately, we evaluate the potential of neuroinflammatory biomarkers of epileptogenesis in meningioma and the current challenges with extrapolating from current literature, which primarily consider epilepsy and intrinsic brain tumors. A prospective randomized controlled trial (STOP'EM: ISRCTN14381346) is open in the UK and will determine the role of two\u2009weeks of prophylactic levetiracetam in seizure\u2010na\u00efve patients undergoing meningioma surgery and provide an opportunity to obtain serial blood measurements from patients to assist with biomarker discovery.<\/jats:p>","DOI":"10.1111\/epi.18559","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T15:58:39Z","timestamp":1753804719000},"page":"4079-4090","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Epileptogenesis in meningioma: Theories, putative biomarkers, and postoperative risk"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7699-3342","authenticated-orcid":false,"given":"William H.","family":"Cook","sequence":"first","affiliation":[{"name":"Division of Neurosurgery University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor S.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bakhsh","sequence":"additional","affiliation":[{"name":"Institute of Systems, Molecular and Integrative Biology University of Liverpool  Liverpool UK"},{"name":"Department of Neurosurgery The Walton Centre NHS Foundation Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony G.","family":"Marson","sequence":"additional","affiliation":[{"name":"Institute of Systems, Molecular and Integrative Biology University of Liverpool  Liverpool UK"},{"name":"Department of Neurology The Walton Centre NHS Foundation Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Jenkinson","sequence":"additional","affiliation":[{"name":"Institute of Systems, Molecular and Integrative Biology University of Liverpool  Liverpool UK"},{"name":"Department of Neurosurgery The Walton Centre NHS Foundation Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel E.","family":"Helmy","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"issue":"5","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"v1","DOI":"10.1093\/neuonc\/noac202","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015\u20102019","volume":"24","author":"Ostrom QT","year":"2022","journal-title":"Neuro Oncol"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noac011"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.06.011"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab106"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.3171\/2015.4.JNS142742"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02285.x"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01444.x"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12711"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-022-04198-y"},{"issue":"7","key":"e_1_2_14_11_1","first-page":"897","article-title":"Impaired health\u2010related quality of life in meningioma patients\u2014a systematic review","volume":"19","author":"Zamanipoor Najafabadi AH","year":"2017","journal-title":"Neuro Oncol"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70018-2"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1997.tb01075.x"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028020948056"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2020.107966"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70103-5"},{"key":"e_1_2_14_17_1","unstructured":"STOP'EM Investigators.Surgeons Trial Of Prophylaxis for Epilepsy in seizure naive patients with Meningioma: a randomised controlled trial (STOP'EM). 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