Abstract
The role of antiepileptic drugs (AED) prophylaxis in primary brain tumor (PBT) seizure-naïve patients remains unclear. Additionally, AED are associated with severe side effects, negative impact on cognition and drug interactions. Little is known about current practice regarding prophylactic AED use in PBT. We investigated its use in a tertiary care cancer center. We reviewed medical records of 260 patients registered in our center between 2008 and 2012, focusing on prophylactic AED use. A descriptive analysis was performed with SPSS IBM version 20.0. Median age was 44.5 years (11–83). Most patients had ECOG PS ≤1 (76.4 %). Among 141 seizure-naïve patients, 70.2 % received an AED as primary prophylaxis (PP). Most commonly used drugs as PP were phenytoin (85.9 %), carbamazepine (6.1 %) and phenobarbital (5.1 %). In only 14 patients (14.1 %) AEDs were eventually discontinued, in a median time of 5.9 months (1.1–76.8 m). AED were used as PP in 60 % of low-grade gliomas, 73.3 % of anaplastic gliomas and 93.9 % of glioblastoma patients. Twenty-seven patients (27.3 %) on PP presented seizures, generally associated with tumor progression. Of the 42 seizure-naïve patients not receiving AED prophylaxis, only two presented seizures, which occurred during or within the first week post-radiotherapy. In this cross-sectional study, prophylactic AED use in PBT was extremely high. Postoperatively, AED were discontinued in a minority of patients, mostly after a prolonged period. Current prophylactic AED use patterns in PBT are not in accordance with established guidelines.
Similar content being viewed by others
References
Glantz MJ, Cole BF, Forsyth PA, Recht LD, Wen PY, Chamberlain MC, Grossman SA, Cairncross JG (2000) Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 54:1886–1893
Moots PL, Maciunas RJ, Eisert DR, Parker RA, Laporte K, Abou-Khalil B (1995) The course of seizure disorders in patients with malignant gliomas. Arch Neurol 52:717–724
Perry J, Zinman L, Chambers A, Spithoff K, Lloyd N, Laperriere N (2006) The use of prophylactic anticonvulsants in patients with brain tumours-a systematic review. Curr Oncol 13:222–229
Agbi CB, Bernstein M (1993) Seizure prophylaxis for brain tumour patients. Brief review and guide for family physicians. Can Fam Physician 39: 1153–1156, 1159–1160, 1163-1154
Temkin NR (2002) Prophylactic anticonvulsants after neurosurgery. Epilepsy Curr 2:105–107. doi:10.1046/j.1535-7597.2002.00038.x
Glantz MJ, Cole BF, Friedberg MH, Lathi E, Choy H, Furie K, Akerley W, Wahlberg L, Lekos A, Louis S (1996) A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumors. Neurology 46:985–991
Forsyth PA, Weaver S, Fulton D, Brasher PM, Sutherland G, Stewart D, Hagen NA, Barnes P, Cairncross JG, DeAngelis LM (2003) Prophylactic anticonvulsants in patients with brain tumour. Can J Neurol Sci 30:106–112
Sirven JI, Wingerchuk DM, Drazkowski JF, Lyons MK, Zimmerman RS (2004) Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc 79:1489–1494. doi:10.4065/79.12.1489
Brouwers MC, Chambers A, Perry J (2003) Can surveying practitioners about their practices help identify priority clinical practice guideline topics? BMC Health Serv Res 3:23. doi:10.1186/1472-6963-3-23-1472-6963-3-23
Lwu S, Hamilton MG, Forsyth PA, Cairncross JG, Parney IF (2010) Use of peri-operative anti-epileptic drugs in patients with newly diagnosed high grade malignant glioma: a single center experience. J Neurooncol 96:403–408. doi:10.1007/s11060-009-9977-2
Siomin V, Angelov L, Li L, Vogelbaum MA (2005) Results of a survey of neurosurgical practice patterns regarding the prophylactic use of anti-epilepsy drugs in patients with brain tumors. J Neurooncol 74:211–215. doi:10.1007/s11060-004-6912-4
Chang SM, Parney IF, Huang W, Anderson FA Jr, Asher AL, Bernstein M, Lillehei KO, Brem H, Berger MS, Laws ER (2005) Patterns of care for adults with newly diagnosed malignant glioma. JAMA 293:557–564. doi:10.1001/jama.293.5.557
North JB, Penhall RK, Hanieh A, Frewin DB, Taylor WB (1983) Phenytoin and postoperative epilepsy. A double-blind study. J Neurosurg 58:672–677. doi:10.3171/jns.1983.58.5.0672
Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR (1990) A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 323:497–502. doi:10.1056/NEJM199008233230801
Wu AS, Trinh VT, Suki D, Graham S, Forman A, Weinberg JS, McCutcheon IE, Prabhu SS, Heimberger AB, Sawaya R, Wang X, Qiao W, Hess KR, Lang FF (2013) A prospective randomized trial of perioperative seizure prophylaxis in patients with intraparenchymal brain tumors. J Neurosurg 118:873–883. doi:10.3171/2012.12.JNS111970
Engrand N, Osinski D (2012) Antiepileptic prophylaxis for elective neurosurgery. Ann Fr Anesth Reanim 31:e235–e246. doi:10.1016/j.annfar.2012.08.004
Englot DJ, Berger MS, Barbaro NM, Chang EF (2011) Predictors of seizure freedom after resection of supratentorial low-grade gliomas. A review. J Neurosurg 115:240–244. doi:10.3171/2011.3.JNS1153
Ramamurthi B, Ravi B, Ramachandran V (1980) Convulsions with meningiomas: incidence and significance. Surg Neurol 14:415–416
Ethical standards statement
I hereby declare that the experiments of our study, entitled “ANTIEPILEPTIC DRUG PROPHYLAXIS IN PRIMARY BRAIN TUMOR PATIENTS: IS CURRENT PRACTICE IN AGREEMENT TO THE CONSENSUS?”, were approved by the local ethics research committee and comply with the current laws of the country in which they were performed.
Conflict of interest
I hereby declare that none of the authors of this paper bear any kind of conflict of interests regarding the subject of our study entitled “ANTIEPILEPTIC DRUG PROPHYLAXIS IN PRIMARY BRAIN TUMOR PATIENTS: IS CURRENT PRACTICE IN AGREEMENT TO THE CONSENSUS?”
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
de Oliveira, J.A., Santana, I.A., Caires, I.Q.S. et al. Antiepileptic drug prophylaxis in primary brain tumor patients: is current practice in agreement to the consensus?. J Neurooncol 120, 399–403 (2014). https://doi.org/10.1007/s11060-014-1564-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-014-1564-5