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Long-term antiseizure medication use in patients after meningioma resection: identifying predictors for successful weaning and failures

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Abstract

Objective

To define risk factors for meningioma-related seizures and predictors of successful weaning of antiseizure medications following meningioma resection.

Methods

This is a retrospective study of 95 patients who underwent meningioma resection at a single institution. Primary outcome analyzed was ability to achieve seizure freedom without the use of anti-seizure medication at 6-months, 1-year, and last known follow up. Secondary outcome was postoperative seizure freedom.

Results

Preoperative seizures (OR: 11.63, 95% CI [3.64, 37.17], p < 0.0001), non-skull base tumor location (OR: 3.01, 95% CI [1.29, 7.02], p = 0.0128), and modified STAMPE score of 3–5 (OR: 5.42, 95% CI [2.18, 13.52], p = 0.0003) were associated with greater likelihood of remaining on antiseizure medication at 6-month follow up. Preoperative seizures (OR: 4.93, 95% CI: [2.00, 12.16 ], p = 0.0008), intratumoral calcifications (OR: 4.19, 95% CI: [1.61, 14.46], p = 0.0055), modified STAMPE score of 3–5 (OR: 5.42, CI [2.18, 13.52], p = 0.0003), and Ki67 greater than 7% (OR: 5.68, CI [1.61, 20.10], p = 0.0060) were significant risk factors for inability to discontinue ASMs by last follow up. Preoperative seizures (OR: 4.33, 95% CI [1.59, 11.85], p = 0.0050) and modified STAMPE score of 3–5 (OR: 6.09, 95% CI [2.16, 17.20], p = 0.0007) were significant risk factors for postoperative seizures.

Conclusions

Preoperative seizures, modified STAMPE2 score of 3–5, non-skull base tumor location, intratumoral calcifications, and Ki67 > 7% were significant risk factors for inability to achieve seizure freedom without ASMs. In addition, the modified STAMPE2 score successfully predicted increased seizure risk following meningioma resection for patients with a score of 3 or higher.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Erin M. Ellis, Michael R. Drumm & Jonathan Huang

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Samhitha M. Rai

  3. Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Matthew C. Tate & Stephen T. Magill

  4. Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jessica W. Templer

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  1. Erin M. Ellis
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  4. Jonathan Huang
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Contributions

E.E., J.T., and M.T. contributed to project development and design. E.E., J.H., S.R., participated in data collection. M.D. and E.E. conducted the data analysis. E.E. wrote the main manuscript text. M.D. and E.E. prepared Tables 1, 2, 3, 4 and 5. J.T. and S.M. provided editorial guidance and analytical support. All authors reviewed the manuscript and contributed suggestions for improvement.

Corresponding author

Correspondence to Erin M. Ellis.

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Competing interests

The authors declare no competing interests.

Disclosures

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was approved by an institutional review board and conducted in line with the principles outlined by their ethical standards and criteria.

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Previous presentations:

An abstract for this project was previously presented as an E-poster at the American Association of Neurological Surgeons annual meeting in Philadelphia, Pennsylvania, April 29 2022.

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Ellis, E.M., Drumm, M.R., Rai, S.M. et al. Long-term antiseizure medication use in patients after meningioma resection: identifying predictors for successful weaning and failures. J Neurooncol 165, 201–207 (2023). https://doi.org/10.1007/s11060-023-04481-6

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