Introduction NICE guidance recognises that the care of patients with CNS malignancy needs to be coordinated. However the pathway for managing BTRE differs across hospitals, with patients presenting to a number of clinicians.

Method Local guidelines for managing BTRE were established in 2015. Weekly BTRE clinic appointments enabled the neurologist to accept referrals primarily from neuro-oncology and neurosurgery.

Results 42 new referrals were seen over 24 months; 40 patients experienced both focal and generalised seizures. The neurologist modified the AED regimen in 18 (42.9%) patients.

Addition of a second AED, most commonly Valproate, was recommended by neurology for 6 (14.3%) patients. This was done primarily to manage focal symptoms, which was successful in 50% cases. Withdrawal of an AED, commonly phenytoin or clobazam, was recommended for 12 (28.5%) patients. Co-existing non epileptic attacks were diagnosed in 3 (7.1%) patients.

32 (76.2%) patients had been prescribed Levetiracetam by the referring clinician, reflecting local guidelines.

Conclusions Establishing local guidelines for the management of BTRE has changed practice regarding the choice of AEDs used, with drugs such as Levetiracetam becoming first line. The neurologist's role is in refining AED regimens and clarifying diagnostic uncertainty. Balancing multiple treatments with quality of life is essential.