Abstract
An American Academy of Neurology practice parameter recommends that long-term prophylactic anti-epileptic drugs (AED) should not be routine in patients with newly diagnosed brain tumors. However, prospective multi-center North American data shows that most newly diagnosed glioma patients receive prophylactic AED. We examined our own peri-operative AED practice patterns in newly-diagnosed patients with malignant glioma to determine if we deviate from published guidelines. A retrospective chart review was performed in adult patients with newly diagnosed malignant gliomas undergoing surgery in southern Alberta between January 2003 and December 2005. Demographic information, AED use, seizure incidence, adverse effects, tumor size, and tumor location were recorded. Of 164 eligible patients, 54 (33%) presented with seizures and all received AED. Prophylactic AED were given to 44 patients (27%). Peri-operative seizures (within 1 week) occurred in two patients without (3%) and no patients with seizure prophylaxis. Adverse AED reactions and adverse effects attributable to seizures were both rare. Prophylactic AED were continued >1 week post-op in 30 patients (18%). Patients receiving prophylactic AED were more likely to have had tumors involving the temporal lobe than those who did not (50 vs. 20%; P < 0.01). Patients receiving peri-operative AED prophylaxis were common, had a trend to reduced peri-operative seizures, and had few adverse effects. However, most of these patients were maintained on prophylactic AED continued beyond the first peri-operative week, contradicting published guidelines. Increased awareness of practice guidelines may help modify AED prescription patterns in malignant glioma patients.
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References
Boarini DJ, Beck DW, VanGilder JC (1985) Postoperative prophylactic anticonvulsant therapy in cerebral gliomas. Neurosurgery 16:290–292
Byrne TN, Cascino TL, Posner JB (1983) Brain metastasis from melanoma. J Neurooncol 1:313–317
Chalk JB, Ridgeway K, Brophy T, Yelland JD, Eadie MJ (1984) Phenytoin impairs the bioavailability of dexamethasone in neurological and neurosurgical patients. J Neurol Neurosurg Psychiatry 47:1087–1090
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
Cohen N, Strauss G, Lew R, Silver D, Recht L (1988) Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 6:1621–1624
De Santis A, Villani R, Sinisi M, Stocchetti N, Perucca E (2002) Add-on phenytoin fails to prevent early seizures after surgery for supratentorial brain tumors: a randomized controlled study. Epilepsia 43:175–182
Dent S, Bociek G (1996) Prophylactic anticonvulsants for cancer patients with newly diagnosed brain metastses. Presented at Proceedings of the American Society of Clinical Oncology
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
Foy PM, Chadwick DW, Rajgopalan N, Johnson AL, Shaw MD (1992) Do prophylactic anticonvulsant drugs alter the pattern of seizures after craniotomy? J Neurol Neurosurg Psychiatry 55:753–757
Franceschetti S, Binelli S, Casazza M, Lodrini S, Panzica F, Pluchino F, Solero CL, Avanzini G (1990) Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumours. Acta Neurochir 103:47–51
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
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
Greenwood RS (2000) Adverse effects of antiepileptic drugs. Epilepsia 41(2):S42–S52
Hagen NA, Cirrincione C, Thaler HT, DeAngelis LM (1990) The role of radiation therapy following resection of single brain metastasis from melanoma. Neurology 40:158–160
Hung S, Hilsenbeck S, Feun L (1991) Seizure prophylaxis with phenytoin in patients with brain metastases. Presented at Proceedings of the American Society of Clinical Oncology
Kuijlen JM, Teernstra OP, Kessels AG, Herpers MJ, Beuls EA (1996) Effectiveness of antiepileptic prophylaxis used with supratentorial craniotomies: a meta-analysis. Seizure 5:291–298
Lee ST, Lui TN, Chang CN, Cheng WC, Wang DJ, Heimburger RF, Lin CG (1989) Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures. Surg Neurol 31:361–364
Liigant A, Haldre S, Oun A, Linnamagi U, Saar A, Asser T, Kaasik AE (2001) Seizure disorders in patients with brain tumors. Eur Neurol 45:46–51
Mahaley MS Jr, Dudka L (1981) The role of anticonvulsant medications in the management of patients with anaplastic gliomas. Surg Neurol 16:399–401
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
North JB, Penhall RK, Hanieh A, Frewin DB, Taylor WB (1983) Phenytoin and postoperative epilepsy. A double-blind study. J Neurosurg 58:672–677
Schaller B, Ruegg SJ (2003) Brain tumor and seizures: pathophysiology and its implications for treatment revisited. Epilepsia 44:1223–1232
van Breemen MS, Vecht CJ (2005) Optimal seizure management in brain tumor patients. Curr Neurol Neurosci Rep 5:207–213
van Breemen MS, Wilms EB, Vecht CJ (2007) Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6:421–430
Wen PY, Marks PW (2002) Medical management of patients with brain tumors. Curr Opin Oncol 14:299–307
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Lwu, S., Hamilton, M.G., Forsyth, P.A. et al. 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 (2010). https://doi.org/10.1007/s11060-009-9977-2
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DOI: https://doi.org/10.1007/s11060-009-9977-2