Background <p>Brain tumor–related epilepsy (BTRE) is a common complication of gliomas and meningiomas, yet data from high-altitude regions in low- and middle-income countries remain limited.</p> Objective <p>To assess the prevalence and clinical features of seizures in patients with gliomas and meningiomas treated at high altitude, and to identify seizure-associated risk factors.</p> Methods <p>We conducted a cross-sectional study of 300 adult patients (150 gliomas, 150 meningiomas) at a tertiary hospital in Quito, Ecuador (2,850 masl) from 2019 to 2023. Patient data were extracted from medical records. Case inclusion was consecutive; equal group sizes were not pre-selected. Statistical analysis included Chi-square tests and ordinal logistic regression.</p> Results <p>Seizures occurred in 42% of patients, with higher frequency in gliomas (50.7%) than meningiomas (33.3%) (<i>p</i> = 0.002). Only 17.6% of patients underwent EEG, with epileptiform activity confirmed in 62.3% of glioma and 37.7% of meningioma cases tested (<i>p</i> = 0.049). Glioma diagnosis (OR = 1.97) and age under 45 (OR = 1.98) were independently associated with seizures. Phenytoin was the most prescribed ASM; levetiracetam was used in only 11% of cases, reflecting limited access.</p> Conclusion <p>BTRE is prevalent among glioma patients and younger individuals in high-altitude settings. Diagnostic limitations, low EEG utilization, and restricted access to newer ASMs hinder optimal care. Prospective studies with follow-up data are needed to evaluate treatment outcomes and reduce disparities in neuro-oncological epilepsy management.</p>