Purpose <p>Epilepsy is among the most prevalent neurological disorders, with one in 10 people experiencing a seizure in their lifetime. In adults, brain tumors are a common cause. While tumor-control outcomes are well studied, less is known about seizure control in this population.</p> Methods <p>We retrospectively reviewed the Clalit Dan–Petah Tikva County database (2000–2019), covering 1.55&#xa0;million patients. Adults with primary brain tumors and epilepsy were identified by ICD-10 codes. Seizure control and management were assessed through anti-seizure medication (ASM) prescriptions, follow-up care, hospitalizations, and evaluation by specialized epilepsy clinics.</p> Results <p>Among 1,557,764 individuals, 17,225 (1.1%) adults were diagnosed with a brain tumor, of whom 14.7% (<i>n</i> = 2,532) had secondary epilepsy. Glioma patients had more than double the epilepsy rate (29.2%, <i>n</i> = 878) compared to meningioma (13.1%, <i>n</i> = 1,417). Most epilepsy cases were associated with benign tumors (65.6%, <i>n</i> = 1,661). Overall, 9.7% (<i>n</i> = 1,672) were classified as high-risk for drug-resistant epilepsy (DRE), yet only 0.5% (<i>n</i> = 89) had a formal diagnosis. Of these, just 12 (0.7%) received follow-up at a specialized epilepsy clinic; the remainder were managed by community neurologists, oncologists, neurosurgeons, or primary care physicians. None of the patients with intractable epilepsy underwent evaluation for epilepsy surgery.</p> Conclusion <p>Despite adequate tumor control, many patients with tumor-related epilepsy continue to experience seizures after resection and oncological treatment, due to suboptimal management or intractability. Under-recognition of DRE and low referral rates to specialized epilepsy centers highlight a significant treatment gap. Improved referral pathways and comprehensive evaluations are needed to optimize seizure outcomes in this population.</p>