Prophylactic Anti-Seizure Medication vs No Anti-Seizure Medication for Patients With Primary Motor Cortex Brain Metastases

Inclusion Criteria:

1. Participants must have a biopsy proven solid malignancy with at least oneintracranial lesion radiographically consistent with or pathologically proven to bea brain metastasis located in the primary motor cortex measuring 0.5 cm or larger inmaximal unidimensional size

2. Age of at least 18 years

3. Karnofsky performance status of at least 60

4. Estimated survival of at least 3-6 months in the opinion of the enrolling clinicianand/or study PI

5. Ability to understand and the willingness to sign a written informed consentdocument by either ink on paper or a DF/HCC approved eConsent medium

Exclusion Criteria:

1. Participants with prior seizures as this is a study for seizure naïve patients

2. Participants with an allergy to levetiracetam as levetiracetam is the prophylacticanti-seizure medication under study

3. Participants concurrently taking (i.e. at enrollment) an ASM for non-seizureindications at clinically relevant doses (gabapentin 1800 mg/day or higher,pregabalin 300 mg/ day or higher, lamotrigine 150 mg/ day or higher, valproic acid 1000 mg/ day or higher, topiramate 200 mg/ day or higher, carbamazepine 200 mg/ dayor higher, oxcarbazepine 300 mg/ day or higher, primidone 100 mg/day or higher)because use of these medications could bias the study toward the null

4. Participants who cannot tolerate a magnetic resonance imaging (MRI) study of thebrain, which is required to determine the presence of and follow the course of brainmetastases under study

5. Participants who cannot receive gadolinium as MRI of the brain with contrast isrequired

6. Participants with end stage renal disease due to risk of nephrogenic systemicfibrosis in this patient population after exposure to gadolinium-based contrastagents

7. Participants with widespread, definitive leptomeningeal disease given thatleptomeningeal disease and brain metastases are different entities

8. Pregnant women are excluded from this study because levetiracetam crosses theplacenta. In addition, the potential deleterious effects of gadolinium on thedeveloping fetus are not completely known

9. Women who are breastfeeding are excluded from this study because levetiracetamenters breast milk. In addition, the potential deleterious effects of gadolinium inbreast milk remain unknown