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Brain tumor location influences the onset of acute psychiatric adverse events of levetiracetam therapy: an observational study

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Abstract

To explore possible correlations among brain lesion location, development of psychiatric symptoms and the use of antiepileptic drugs (AEDs) in a population of patients with brain tumor and epilepsy. The medical records of 283 patients with various types of brain tumor (161 M/122 F, mean age 64.9 years) were analysed retrospectively. Patients with grade III and IV glioma, previous history of epileptic seizures and/or psychiatric disorders were excluded. Psychiatric symptoms occurring after initiation of AED therapy were considered as treatment emergent psychiatric adverse events (TE-PAEs) if they fulfilled the following conditions: (1) onset within 4 weeks after the beginning of AED therapy; (2) disappearance on drug discontinuation; (3) absence of any other identified possible concurrent cause. The possible influence of the following variables were analysed: (a) AED drug and dose; (b) location and neuroradiologic features of the tumor, (c) location and type of EEG epileptic abnormalities, (d) tumor excision already or not yet performed; (e) initiation or not of radiotherapy. TE-PAEs occurred in 27 of the 175 AED-treated patients (15.4%). Multivariate analysis showed a significant association of TE-PAEs occurrence with location of the tumor in the frontal lobe (Odds ratio: 5.56; 95% confidence interval 1.95–15.82; p value: 0.005) and treatment with levetiracetam (Odds ratio: 3.61; 95% confidence interval 1.48–8.2; p value: 0.001). Drug-unrelated acute psychiatric symptoms were observed in 4 of the 108 AED-untreated patients (3.7%) and in 7 of the 175 AED-treated patients (4%). The results of the present study suggest that an AED alternative to levetiracetam should be chosen to treat epileptic seizures in patients with a brain tumor located in the frontal lobe to minimize the possible onset of TE-PAEs.

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Authors and Affiliations

  1. Neurology Unit, S. Anna Hospital, Como, Italy

    Vincenzo Belcastro

  2. Neurology Unit, “Cutrona Zodda” Hospital, Barcellona Pozzo di Gotto, ME, Italy

    Laura Rosa Pisani

  3. Neurosurgery Unit, S. Anna Hospital, Como, Italy

    Silvio Bellocchi & Paolo Casiraghi

  4. Neurology Unit, S. Giovanni di Dio Hospital, Crotone, Italy

    Gaetano Gorgone

  5. Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals, NHS Foundation Trust and Institute of Medical and Biomedical Sciences, St George’s University of London, London, UK

    Marco Mula

  6. Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy

    Francesco Pisani

Authors
  1. Vincenzo Belcastro
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  2. Laura Rosa Pisani
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  3. Silvio Bellocchi
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  4. Paolo Casiraghi
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  5. Gaetano Gorgone
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  6. Marco Mula
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  7. Francesco Pisani
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Correspondence to Vincenzo Belcastro.

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Conflicts of interest

MM has received consultancy fees from UCB Pharma, Eisai, Pfizer and Elsevier and has also received supports from Bial and Special Products Ltd. Vincenzo Belcastro, Laura Rosa Pisani, Paolo Casiraghi, Silvio Bellocchi, Gaetano Gorgone, Francesco Pisani declare that they have not conflict of interest.

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Belcastro, V., Pisani, L.R., Bellocchi, S. et al. Brain tumor location influences the onset of acute psychiatric adverse events of levetiracetam therapy: an observational study. J Neurol 264, 921–927 (2017). https://doi.org/10.1007/s00415-017-8463-6

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  • DOI: https://doi.org/10.1007/s00415-017-8463-6

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